Original articleChronic pancreatitis: An international draft consensus proposal for a new mechanistic definition
Section snippets
Propositional mechanistic definition of CP
“Chronic pancreatitis is a pathologic fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental and/or other risk factors who develop persistent pathologic responses to parenchymal injury or stress.”
In addition, the following features of the CP syndrome may or may not be present in individual cases:
“Common features of established and advanced CP include pancreatic atrophy, fibrosis, pain syndromes, duct distortion and strictures, calcifications, pancreatic exocrine
Methods
A systematic literature review of major consensus reports, invited expert reviews, systematic reviews, and landmark papers that were published between 1965 and 2014 on recurrent acute pancreatitis (RAP) and CP was performed by DCW and JBG. Various consensus statements were organized and viewed from a historical perspective to understand the basis for recommendations or their attempt to revise previously published recommendations. Summary information was circulated among authors from India [PKG]
Results
The working group chose to present highlights from key historical conferences/consensus meetings focused on CP to provide the framework of the current clinicopathologic-based definition. Second, the limitations of a clinicopathologic definition are presented. Third, the rationale for the framework of a mechanistic definition of CP is provided. Fourth, a conceptual model of the process of CP, extending from risk to end-stage disease is outlined. In addition to the proposed definition statements,
Discussion
A useful definition is a statement of the meaning of a term that both describes a concept and delineates the inclusion/exclusion boundaries. We believe that traditional definitions of CP tend to be extensional (listing the features) rather than intensional (describing the essence of the concept), which is problematic when the features are nonspecific and the goal is early detection linked to and targeted at, preventative treatments. A mechanistic definition overcomes these limitations by
Acknowledgments
The authors thank David Fine MD and Mark D. Topazian MD for critical review of the manuscript. DCW was supported by R21DK098560. DY and DCW were supported by DK077906 and 1U01DK108306. There was no conflict of interest.
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