Title of paper: Tropical pancreatitis - a distinct entity, or merely a type of chronic pancreatitis?
Authors: Balakrishnan V, Nair Prem, Radhakrishnan Lakshmi, Narayanan VA
Digestive Diseases Institute, Amrita Institute of Medical Sciences, Cochin 682 026, India
Tropical pancreatitis was described 50 years ago as a disease of the tropical regions, particularly southern India, with young age at onset, malnutrition, rapid progression, severe pancreatic damage with multiple large ductal calculi, and absence of history of alcoholism or biliary tract disease as its hallmarks.
Over the years, chronic pancreatitis in southern India has shown a change, with increase in older patients, occurrence of milder disease including milder diabetes, increasing longevity, and increasing association with alcoholism and smoking.
This article looks at changes in the disease and in dietetic, environmental and socioeconomic factors over the years, in an attempt to understand the environment-gene interactions in its causation. This analysis shows that tropical pancreatitis (TP) may represent one end of the wide spectrum of chronic pancreatitis in the tropics, with alcoholic pancreatitis (AP) representing the other extreme.
The etiology of TP remains unknown. Since poverty and malnutrition were common in the countries from where the disease had been reported, malnutrition was suspected as a major causative factor and hence the disease was even described as "nutritional pancreatitis". Consumption of a tuber, named cassava or tapioca, being common in the populations afflicted by TP, was also suspected to play a causative role. However, evidence in support of the nutritional origin and the cassava hypothesis for TP remains inadequate.
Familial clustering of TP has been reported, particularly in Kerala, raising the possibility of a familial or hereditary etiological factor. Family studies, however, did not reveal a specific pattern of inheritance. Further, family clustering could result from common environmental or dietary factors.
The term 'tropical', reflecting the disease's geographical distribution, became a part of the disease's name, and by conjuring images of poverty and malnutrition, led to a tendency among early workers to treat TP as 'a disease of deprivation'.
This paper looks at current understanding of AP and TP, which seem to be two ends of the spectrum of CP. For example, AP is often caused not by alcohol alone, but also by co-factors such as smoking, diet (high protein, high fat or very low fat) and genetic influences. Similarly, in TP, which is considered as being caused by food toxins or by micronutrient deficiency, secondary co-factors such as alcohol, even in small quantities, smoking and other environmental toxins may play a role. In a particular patient, more than one etiological factor may operate in tandem, and their nature and relative contributions may determine the clinical manifestations of CP.
To read full paper, please click on the link below. For more information on the journal, please contact Dr DK Sahu at the email link above.
How to cite this article:
Balakrishnan V, Nair P, Radhakrishnan L, Narayanan VA. Tropical pancreatitis - a distinct entity, or merely a type of chronic pancreatitis?. Indian J Gastroenterol 2006;25:74-81
How to cite this URL:
Balakrishnan V, Nair P, Radhakrishnan L, Narayanan VA. Tropical pancreatitis - a distinct entity, or merely a type of chronic pancreatitis?. Indian J Gastroenterol [serial online] 2006 [cited 2006 Jun 8];25:74-81. Available from: http://www.indianjgastro.com/article.asp?issn=0254-8860;year=2006;volume...