Pancreatitis (synonym: pancreatitis; pancreatitis; ICD-10: K85.- – Acute pancreatitis) is an inflammation of the pancreas. Most acute pancreatitis is mild and heals with conservative therapy. Severe forms of the disease – especially necrotizing pancreatitis – can cause problems and still have a high mortality rate. In northern Germany, about 20 out of every 100,000 inhabitants develop pancreatitis each year. Most people fall ill between the ages of 35 and 44.
A distinction is made according to the course:
- Acute (sudden) pancreatitis (AP).
- Chronic – slowly developing – pancreatitis (CP; 70-90% of cases are caused by excessive alcohol consumption).
Acute pancreatitis is classified morphologically as follows:
- Interstitial edematous pancreatitis – in this case, the inflammation is limited to the pancreatic parenchyma (organ-specific tissue of the pancreas) and the surrounding pancreatic tissue; necrosis (“local tissue death”) does not occur! Most common entity with about 85% of cases; course is usually mild and self-limiting.
- Necrotizing pancreatitis – occurrence of necrosis of the pancreatic parenchyma (“cell death” of the functional tissue of the pancreas) and or peripancreatic (“around the pancreas (pancreas)”) necrosis; about 15% of cases; intensive therapy required; condition is associated with a high mortality (death rate).
Recently, the picture of autoimmune pancreatitis has also been described. This may occur in association with other autoimmune diseases, is associated with an increase in serum immunoglobulins type Ig G4 and improves with treatment with corticosteroids.
The diagnosis of “idiopathic acute pancreatitis” (“disease, without a tangible cause”) is made in approximately 10% of cases:Note: Acute pancreatitis may also be the initial manifestation of pancreatic cancer (pancreatic cancer).
Sex ratio: acute pancreatitis: women more common than men; chronic pancreatitis: men more common than women.
Frequency peak: the maximum of occurrence of acute pancreatitis is between 20-40 and 40-60 years of age. The maximum incidence of chronic pancreatitis is between the ages of 35 and 44.
The incidence (frequency of new cases) of acute pancreatitis is 4.9-80 cases per 100,000 inhabitants per year (in Germany). The incidence for chronic pancreatitis correlates with alcohol consumption and is 5-10 diseases per 100,000 inhabitants per year (in Germany). Worldwide, the prevalence is 1.6-23 diseases per 100,000 inhabitants per year.
Course and prognosis: Acute pancreatitis is usually mild and results in a median hospital stay of about 5 days. If necrotizing pancreatitis occurs (about 15% of cases; see above), therapy should be provided at a center.Pancreatitis often occurs recurrently (recurring). The recurrence rate is 50-90%. Patients with chronic alcohol consumption have the highest recurrence rate. Recurrent episodes of inflammation cause the pancreatic parenchyma (pancreatic tissue) to be replaced by fibrotic connective tissue. As a result of this connective tissue remodeling of the pancreas, there is a progressive loss of exocrine (relating to digestive enzymes) and endocrine (relating to hormones) pancreatic function.
The lethality (mortality related to the total number of people suffering from the disease) of necrotizing pancreatitis is 25% to 45%. Chronic pancreatitis results in a 23% reduction in life expectancy. The lethality of chronic pancreatitis is reported to be 16-20% over an observation period of 6-10 years.
The 10-year survival rate of chronic pancreatitis is approximately 70% and the 20-year survival rate is approximately 45%.
