Analysis of the etiology in 458 pancreatitis patients according to the M-ANNHEIM multiple risk factor classification

Background: Chronic pancreatitis (cP) represents a complex disorder with interaction of various risk factors. The M-ANNHEIM classification addresses this issue and stratifies multiple (M) etiological risk factors such as Alcohol (A), Nicotine (N), Nutrition (N), Heredity (H), Efferent duct factors (E), Immunity (I), Miscellaneous factors (M), differentiates various disease stages and defines different degrees of disease severity.

Objectives: To identify the interaction and frequency of known etiological risk factors in pancreatitis patients.

Methods: Patients (n=458 with sufficient data, exclusion of biliary pancreatitis) from our clinic in Germany (1997–2008) were classified according to the M-ANNHEIM classification.

Results: In n=172/458 patients (38%, n=49 borderline cP, n=123 definite or probable cP), only up to one etiological risk factor was found. In n=286/458 patients (62%, n=62 borderline cP, n=224 definite or probable cP), two or more risk factors were identified. Alcohol was observed as a risk factor in n=266/465 (58%) patients. Nicotine was found in n=311/458 (68%) individuals. Alcohol was found in n=25/172 (15%) and Nicotine in n=44/172 (26%) patients with up to one risk factor. Alcohol was detected in n=241/286 (84%) and Nicotine in n=267/286 (93%) patients with multiple risk factors. Interaction of Alcohol with Nicotine was found in n=236/286 (83%) patients with multiple risk factors. Idiopathic disease without any known etiological risk factor was identified in only n=56/458 (12%) patients.

Conclusion: Nicotine is more frequently found as a risk factor of pancreatic inflammation than Alcohol. Idiopathic pancreatitis with absence of any known risk factor is rare.