Diagnostic criteria, classification and clinical course in pancreatitis

1. Alcohol was the most common cause of pancreatitis, irrespective of sex or age. The acute hemorrhagic necrotizing form could arise after the consumption of no more than 100-450 g of alcohol a day for 7-10 days. Chronic pancreatitis was almost invariably caused by alcohol. 2. While alcohol predominantly (93%) among the under-60s, biliary tract disease and cancer were a major cause (53%) of pancreatitis in the over-60s. 3. Pancreatitis usually followed one of three courses: acute hemorrhagic, acute oedematous (acute pancreatitis) or chronic. 4. Patients who have been treated for alcoholic pancreatitis have a high death rate. The mean age at death was 46 years. 5. Most cases of acute hemorrhagic, necrotizing pancreatitis (92%) occurred as the patient's first attack of pancreatitis. 6. The diagnosis acute hemorrhagic, necrotizing pancreatitis can at present be established only at operation or autopsy. 7. Extensive resection of the pancreas should be avoided in acute hemorrhagic necrotizing pancreatitis because the function of the pancreas was often acceptably restituted once the disorder had subsided. 8. Disturbed sugar regulation was the most common complication in patients who had had pancreatitis. Diabetes mellitus often occurred (29%) and might do so months or years after an attack. 9. Patients with alcoholic pancreatitis were greatly disadvantaged socially (little education, poor jobs and housing) and in the event of a recurrence elicited by alcohol it is suggested that they should be cared for at a department for alcoholics. 10. It is suggested that in chronic pancreatitis the diagnosis should specify any exocrine and endocrine disturbances as well as any morphological changes that have been documented by i.e. ERCP or ultrasound. Studies of pancreatic function and morphology for the classification of pancreatitis should be made no earlier than 6 weeks after clinical signs of pancreatitis have subsided, with abstention from alcohol in the intervals. A classification of this type would contribute to a better follow-up and treatment of patients with chronic pancreatitis and improve the possibility of comparing patient materials.