Pancreas divisum as a predisposing factor for chronic and recurrent idiopathic pancreatitis: initial in vivo survey

Gut. 2011 Aug;60(8):1103-8. doi: 10.1136/gut.2010.230011. Epub 2011 Feb 15.

Abstract

Background: It is a controversial issue whether pancreas divisum (PD) induces pancreatitis. All previous studies have investigated this issue based on endoscopic procedures, which inevitably involve a selection bias.

Objectives: To determine the unbiased prevalence rate of PD in a community population and to investigate the effect of PD on idiopathic pancreatitis using a non-invasive magnetic resonance (MR) technique.

Design: Cross-sectional study.

Patients: The study enrolled 504 subjects from the community who participated in the medical check-up programme and 46 patients with idiopathic pancreatitis (8 acute, 23 chronic, 15 recurrent) extracted from 70,122 consecutive MR studies performed at an academic tertiary care hospital.

Interventions: All subjects underwent magnetic resonance (MR) scanning and medical examination.

Main outcome measures: Statistical comparison between subjects from the community and patients with idiopathic pancreatitis was made for the rate of PD (and its subtypes: classical PD, PD with absent ventral duct, and incomplete PD), MR findings, and clinical features.

Results: Multiple logistic regression analysis revealed PD as a significant factor that induces pancreatitis (OR 23.4; p<0.0001). The PD rate was significantly higher for all/chronic/recurrent idiopathic pancreatitis patients (35%/43%/33%; p<0.001 for all) than for subjects in the community group (2.6%), but was not higher for acute pancreatitis (13%; p=0.357). All PD subtypes were indicated to induce idiopathic pancreatitis but showed different associations with each onset type of pancreatitis.

Conclusions: This is the first study to describe the prevalence of PD and PD subtypes in a community population and their association with idiopathic pancreatitis in vivo based on the findings of non-invasive MR and with minimal selection bias. It is concluded that PD should be considered a predisposing factor for chronic and recurrent pancreatitis.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cholangiopancreatography, Endoscopic Retrograde
  • Cross-Sectional Studies
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Humans
  • Japan / epidemiology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Pancreas / abnormalities*
  • Pancreatitis, Chronic / diagnosis
  • Pancreatitis, Chronic / epidemiology
  • Pancreatitis, Chronic / etiology*
  • Population Surveillance / methods*
  • Prevalence
  • Prognosis
  • Recurrence
  • Retrospective Studies
  • Risk Factors