Study of early chronic pancreatitis needs to be improved

Abstract

Dear editor, We read with interest the recent published study of early chronic pancreatitis (CP) [1] and we found that study design could be improved. First, patients enrolled in this study were not given proper lifestyle guidance. As the author stated, alcohol consumption was the well-known risk factor for CP. The risk of pancreatitis recurrence was 2.5-fold in patients who continued drinking but with decreased amounts and 7.1fold in patients who continued drinking as before compared with patients who completely abstained [2]. Therefore, alcohol abstinence should be suggested to patients with high risk of CP. However, for four patients progressed to definite CP, three patients consumed excessive alcohol ([ 80 g/day) as before 2 years after entry. For 79 patients who did not progress, 39.2% patients consumed excessive alcohol at entry and still 39.2% patients consumed excessive alcohol 2 years after entry. Were they suggested to stop drinking alcohol at entry? Why is ratio of patients consuming excessive alcohol so high? Second, usage of camostat mesilate and pancrelipase should be compared between patients remained as early CP and those downgraded. Camostat mesilate is a serine protease inhibitor which is often used in CP patients. Pancrelipase is applied in patients with decreased pancreatic exocrine function. For 79 patients did not progressed, 63.3% (50/79) and 43.0% (34/79) patients had used camostat mesilate and pancrelipase, separately, while usage of these drugs should be analyzed in two subgroups of the 79 patients (patients remained as early CP and those downgraded). Whether usage of these drugs contributed to degradation of 39.2% early CP is valuable, because this might indicate that the early CP status could be reversed using these drugs. Third, current criteria for alcoholic etiology of early CP were unreasonable. Consumption of 80 g/day of pure ethanol was set to be the classification criteria of alcoholic early CP for both genders. However, most studies defined alcohol-related CP when alcohol intake exceeded 80 g/day for males or 60 g/day for females for at least 2 years [3]. Some studies even considered alcohol-related CP when alcohol intake exceeded 80 g/day for males or 40 g/day for females [4]. Considering that 41% were female patients, using the same criteria as for male patients to identify alcoholic early CP for female patients would cause much bias. In conclusion, the valuable study could be improved in terms of data exhibition and analysis.