The Etiology of Chronic Pancreatitis in Low and ...
French authors（Sarles et al.1979）have reported a particular form of chronic pancreatitis in India found in malnourished in childhood having a low fat and low protein diet.This form of the disease was called“tropical pancreatitis”and it is defined as a form of chronic pancreatitis and it is clinically characterized by abdominal pain，intraductal calculi and diabetes mellitus in young non-alcoholic subjects.The first description of this disease included a series of 45 patients with pancreatic calcifications associated with diabetes mellitus who were of low economic class and consumed a protein-and calorie-deficient diet，and who were malnourished，emaciated，has an increase in size of parotids，and had hair and skin changes similar to that of Kwashiorkor（Zuidema 1959）.Similar findings were then reported from various tropical countries in Asia（India，Bangladesh，Sri Lanka）（Chari et al.1992；Tandon et al.2002）and Africa（Uganda，Nigeria，Zambia，Madagascar，Ethiopia）（Lester 1993）.Thus，tropical pancreatitis has been recognized as a distinct entity with unique clinical and epidemiological features different from that of alcoholic chronic pancreatitis.Subsequent studies coming from India and Africa confirmed these findings（Mohan et al.2003）.In these countries，recent data have also shown important changes in the etiology of chronic pancreatitis.In fact，idiopathic chronic pancreatitis was the predominant etiology accounting for 57.0-69.9%of all cases of chronic pancreatitis（Rajesh et al.2014）.However，an increase in the prevalence of alcoholic chronic pancreatitis（41%）was noted whereas hypertriglyceridemia and hyperparathyroidism were less common causes of non-alcoholic chronic pancreatitis and，finally，autoimmune pancreatitis remains a rare cause of the disease（Rajesh et al.2014）.Of course，the increase in alcoholic pancreatitis in India as an etiological factor of chronic pancreatitis represents the changing lifestyle in this country，but the increase in the idiopathic form of the disease has no explanation.In these countries，the clinical assessment of the etiology of chronic pancreatitis probably requires more effort，and the limit of 80 g of pure alcohol per day for at least 5 years should be revised according to the new international organization against the recommendations for alcohol use（Pezzilli 2015）.(https://www.daowen.com)