The Frequency of Change in Etiology

The discovery of new factors able to induce chronic pancreatitis，new forms of chronic pancreatitis and changes in lifestyle of patients having chronic pancreatitis contribute to the changes in frequencies of the etiologies of chronic pancreatitis.Thus，from 2004 various studies carried out around the world have claimed that the etiological features of chronic pancreatitis are different to those reported in the past.For example，in Korea（Ryu et al.2005），even if the main etiological factor of chronic pancreatitis remains alcohol（64.3%）the frequency of idiopathic chronic pancreatitis is increased（20.8%），followed by obstructive（8.6%）and autoimmune pancreatitis（2.0%）.On the other hand，in the Asian-Pacific region（Garg and Tandon 2004），the frequency of alcoholic pancreatitis is highly variable，ranging from 19%of chronic pancreatitis cases in China to 95%in Australia.Finally，tropical pancreatitis is 46.4%in China and it is not present in Australia.Also in Italy has been observed that chronic pancreatitis associated with alcohol abuse accounted for less than 50% of cases（Frulloni et al.2009），and this figure is lower than that reported by Gullo et al.in 1977（Gullo et al.1977）.However，it is important to note that in Italy there are regional differences regarding the frequency of alcoholic chronic pancreatitis；in Northern Italy，alcohol is the main etiological factor（80.4%）（Pezzilli et al.2007），whereas in Southern Italy，the percentage of alcoholic chronic pancreatitis dropped to 60%（Montalto et al.1990）.In addition，after alcohol abuse，obstruction（27%），pancreatitis of unknown origin（17%），autoimmunity（4%）and hereditary/genetic factors（4%）are the other associated factors of chronic pancreatitis in Italy（Frulloni et al.2009）.Surprisingly，in a prospective nationwide study carried out in India（Balakrishnan et al.2008），the authors found that the majority of patients had pancreatitis of unknown origin（60%of the cases）；alcoholic chronic pancreatitis accounted for a third of the cases whereas tropical pancreatitis was present in only 3.8%of the cases.However，these data need to be re-evaluated because the frequency of chronic pancreatitis of unknown origin was 17%in the Italian survey（Frulloni et al.2009）ranging from 12%in Northern Italy（Pezzilli et al.2007）to 38%in Southern Italy（Montalto et al.1990）.

Conclusions(https://www.daowen.com)

The results coming from recent surveys on chronic pancreatitis around the world show that alcohol remains the main factor associated with chronic pancreatitis and that alcohol abuse and smoking habits are independent risk factors for chronic pancreatitis（Yadav et al.2009）.

Autoimmune pancreatitis having a frequency of 2-4%of all case of chronic pancreatitis will probably increase in frequency over the next years.Hereditary chronic pancreatitis has a low impact on the etiology of acute pancreatitis but it is highly related to the development of cancer（Raimondi et al.2010）.The rise in idiopathic chronic pancreatitis probably indicates our poor clinical confidence in the definition and quantification of risk factors in our patients or，especially in Africa and Asia，the misleading classification of tropical pancreatitis as idiopathic chronic pancreatitis.