Skip to main content
SpringerLink
Log in

Nationwide epidemiological survey of chronic pancreatitis in Japan: introduction and validation of the new Japanese diagnostic criteria 2019

  • Original Article–Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Objectives

To provide updated clinico-epidemiological information on chronic pancreatitis (CP) in Japan.

Methods

We conducted a two-stage nationwide epidemiological survey; the number of CP patients was estimated in the first-stage survey, and their clinical features were examined in the second-stage survey. We surveyed patients with CP who had visited hospitals in 2016 and were diagnosed according to the Japanese diagnostic criteria 2009 (DC2009). Furthermore, we validated the new Japanese diagnostic criteria (DC2019) in patients with early CP diagnosed according to DC2009.

Results

The number of patients with definite/probable CP in 2016 was 56,520 (prevalence, 44.5 per 100,000 persons), and that of early CP was 4470 (prevalence, 3.5 per 100,000 persons). We obtained detailed clinical information of 2150 patients with definite/probable CP and 249 patients with early CP. Compared with the early CP cases, the definite/probable CP cases had higher proportions of male (4.8 vs. 1.3), alcohol-related etiology (72.0% vs. 45.8%), smoking history (69.6% vs. 41.0%), diabetes mellitus (42.3% vs. 19.3%), and past history of acute pancreatitis (AP) (50.4% vs. 22.1%). Among the patients with early CP diagnosed according to DC2009, 93 (37.3%) were diagnosed with early CP according to DC2019, but the diagnosis of the remaining 156 (62.7%) patients was downgraded. Alcohol-related etiology, smoking history, early disease onset, and past history of AP were associated with the maintenance of early CP diagnosis in DC2019.

Conclusion

We clarified the current status of CP in Japan. Further validation studies are warranted to clarify the diagnostic utility of DC2019.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AP:

Acute pancreatitis

BT-PABA:

N-benzoyl-l-tyrosyl-p-aminobenzoic acid

CI:

Confidence interval

CP:

Chronic pancreatitis

DC:

Japanese clinical diagnostic criteria for chronic pancreatitis

DM:

Diabetes mellitus

EUS:

Endoscopic ultrasonography

HP:

Hereditary pancreatitis: MRCP, magnetic resonance cholangiopancreatography

SD:

Standard deviation

References

  1. Whitcomb DC, Frulloni L, Garg P, et al. Chronic pancreatitis: an international draft consensus proposal for a new mechanistic definition. Pancreatology. 2016;16:218–24.

    Article  Google Scholar 

  2. Singh VK, Yadav D, Garg PK. Diagnosis and management of chronic pancreatitis: a review. JAMA. 2019;322:2422–34.

    Article  CAS  Google Scholar 

  3. Kleeff J, Whitcomb DC, Shimosegawa T, et al. Chronic pancreatitis. Nat Rev Dis Primers. 2017;3:17060.

    Article  Google Scholar 

  4. Lin Y, Tamakoshi A, Matsuno S, et al. Nationwide epidemiological survey of chronic pancreatitis in Japan. J Gastroenterol. 2000;35:136–41.

    Article  CAS  Google Scholar 

  5. Otsuki M. Chronic pancreatitis in Japan: epidemiology, prognosis, diagnostic criteria, and future problems. J Gastroenterol. 2003;38:315–26.

    Article  Google Scholar 

  6. Tashiro M, Nishimori I, Otsuki M, et al. Nationwide epidemiological survey of chronic pancreatitis in Japan. Pancreas. 2005;31:473 (abstract).

    Article  Google Scholar 

  7. Hirota M, Shimosegawa T, Masamune A, et al. The sixth nationwide epidemiological survey of chronic pancreatitis in Japan. Pancreatology. 2012;12:79–84.

    Article  Google Scholar 

  8. Hirota M, Shimosegawa T, Masamune A, et al. The seventh nationwide epidemiological survey for chronic pancreatitis in Japan: clinical significance of smoking habit in Japanese patients. Pancreatology. 2014;14:490–6.

    Article  Google Scholar 

  9. Ito T, Ishiguro H, Ohata H, et al. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J Gastroenterol. 2016;51:85–92.

    Article  Google Scholar 

  10. Shimosegawa T, Kataoka K, Kamisawa T, et al. The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol. 2010;45:584–91.

    Article  Google Scholar 

  11. Masamune A, Kikuta K, Nabeshima T, et al. Nationwide epidemiological survey of early chronic pancreatitis in Japan. J Gastroenterol. 2017;52:992–1000.

    Article  Google Scholar 

  12. Masamune A, Nabeshima T, Kikuta K, et al. Prospective study of early CP diagnosed based on the Japanese diagnostic criteria. J Gastroenterol. 2019;54:928–35.

    Article  Google Scholar 

  13. Japan Pancreas Society. Clinical diagnostic criteria for chronic pancreatitis 2019. J Jpn Pancreas Soc (Suizou). 2019;34:279–81 (in Japanese).

    Article  Google Scholar 

  14. Masamune A, Kikuta K, Hamada S, et al. Clinical practice of acute pancreatitis in Japan: an analysis of nationwide epidemiological survey in 2016. Pancreatology. 2020;20:629–36.

    Article  CAS  Google Scholar 

  15. Masamune A, Kikuta K, Hamada S, et al. Nationwide epidemiological survey of autoimmune pancreatitis in Japan in 2016. J Gastroenterol. 2020;55:462–70.

    Article  Google Scholar 

  16. Wakai K, Ohta A, Tamakoshi A, et al. Estimated prevalence and incidence of adult Still's disease: findings by a nationwide epidemiological survey in Japan. J Epidemiol. 1997;7:221–5.

    Article  CAS  Google Scholar 

  17. Kuriyama S, Kusaka Y, Fujimura M, et al. Prevalence and clinicoepidemiological features of moyamoya disease in Japan: findings from a nationwide epidemiological survey. Stroke. 2008;39:42–7.

    Article  Google Scholar 

  18. Xiao AY, Tan ML, Wu LM, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol. 2016;1:45–55.

    Article  Google Scholar 

  19. Capurso G, Archibugi L, Pasquali P, et al. Prevalence of chronic pancreatitis: results of a primary care physician-based population study. Dig Liver Dis. 2017;49:535–9.

    Article  Google Scholar 

  20. Lévy P, Domínguez-Muñoz E, Imrie C, et al. Epidemiology of chronic pancreatitis: burden of the disease and consequences. United European Gastroenterol J. 2014;2:345–54.

    Article  Google Scholar 

  21. Yadav D, Timmons L, Benson JT, et al. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol. 2011;106:2192–9.

    Article  Google Scholar 

  22. Sellers ZM, MacIsaac D, Yu H, et al. Nationwide trends in acute and chronic pancreatitis among privately insured children and non-elderly adults in the United States, 2007–2014. Gastroenterology. 2018;155:469–78.e1.

    Article  Google Scholar 

  23. Masamune A, Kume K, Shimosegawa T. Sex and age differences in alcoholic pancreatitis in Japan: a multicenter nationwide survey. Pancreas. 2013;42:578–83.

    Article  Google Scholar 

  24. Ammann RW, Buehler H, Muench R, et al. Differences in the natural history of idiopathic (nonalcoholic) and alcoholic chronic pancreatitis. a comparative long-term study of 287 patients. Pancreas. 1987;2:368–77.

    Article  CAS  Google Scholar 

  25. Hao L, Wang LS, Liu Y, et al. The different course of alcoholic and idiopathic chronic pancreatitis: a long-term study of 2037 patients. PLoS ONE. 2018;13:e0198365.

    Article  Google Scholar 

  26. Olesen SS, Nøjgaard C, Poulsen JL, et al. Chronic pancreatitis is characterized by distinct complication clusters that associate with etiological risk factors. Am J Gastroenterol. 2019;114:656–64.

    Article  Google Scholar 

  27. Vanga RR, Tansel A, Sidiq S, et al. Diagnostic performance of measurement of fecal elastase-1 in detection of exocrine pancreatic insufficiency: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16:1220–8.e4.

    Google Scholar 

  28. Kataoka K, Yamane Y, Kato M, et al. Diagnosis of chronic pancreatitis using noninvasive tests of exocrine pancreatic function: comparison to duodenal intubation tests. Pancreas. 1997;15:409–15.

    Article  CAS  Google Scholar 

  29. Otsuki M, Nishimori I, Hayakawa T, et al. Hereditary pancreatitis: clinical characteristics and diagnostic criteria in Japan. Pancreas. 2004;28:200–6.

    Article  Google Scholar 

  30. Aoun E, Chang CC, Greer JB, Papachristou GI, Barmada MM, Whitcomb DC. Pathways to injury in CP: decoding the role of the high-risk SPINK1 N34S haplotype using meta-analysis. PLoS ONE. 2008;3:e2003.

    Article  Google Scholar 

  31. Tang XY, Zou WB, Yu FF, et al. Meta-analysis of the impact of the SPINK1 c.194 + 2T > C variant in chronic pancreatitis. Dig Liver Dis. 2020;52:143–8.

    Article  CAS  Google Scholar 

  32. Masamune A, Kikuta K, Hamada S, et al. Nationwide survey of hereditary pancreatitis in Japan. J Gastroenterol. 2018;53:152–60.

    Article  CAS  Google Scholar 

  33. Masamune A, Kotani H, Sörgel FL, et al. Variants that affect function of calcium channel TRPV6 are associated with early-onset chronic pancreatitis. Gastroenterology. 2020;158:1626–41.e8.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the doctors who replied to the questionnaires.

Collaborators: Shin Miura , Tetsuya Takikawa , Seiji Hongo , Eriko Nakano , Tatsuhide Nabeshima , Ryotaro Matsumoto , Yu Tanaka , Masayuki Ueno , Tsuyoshi Mukai , Masataka Matsumoto , Yasushi Kudo , Shunjiro Azuma , Kosuke Okuwaki , Satoshi Yamamoto , Kazuo Inui , Kasen Kobashigawa , Jun Unno , Nao Fujimori , Katsuya Kitamura , H iroyuki Miyakawa , Kuniyuki Takahashi , Tsukasa Ikeura , Kazuichi Okazaki , Mamoru Takenaka , Mitsuharu Fukasawa , Hiroyuki Funayama , Akira Mitoro , Tadayuki Takagi , Masanari Sekine , Kanetoshi Suwa , Junichi Sakagami , Masaharu Ishida , Masayuki Ohtsuka , S hingo Kagawa , Takashi Muraki , Takayuki Watanabe , Takashi Watanabe , Katsunori Yamamoto , T omohiro Masaka , Masatsugu Nagahama , Ai Sato , Yukio Aruga , Yousuke Nakai , Eisuke Iwasaki , T akao Itoi , Yuki Kawaji , Masayuki Kitano , Kazuhiro Mizukami , Susumu Iwasaki , Masashi Mori , Naoya Kaneko , Yuzo Kodama , Hiroko Sato , Naoki Yoshida , Katsuko Hatayama , Takashi Kobayashi , Atsuyuki Hirano , Miyuki Kaino , Toshio Fujisawa , Tomoyuki Ushijima , Mitsuru Chiba , K yoko Shimizu , Hirotaka Ota , Masao Toki , Takao Nishikawa , Yu Yoshida , Kei Tanaka , Kota Uetsuki , Daisuke Motoya , Shinichiro Muro , Hiroyuki Watanabe , Yoshiki Imamura , Tetsuya Ishizawa , Terumi Kamisawa , M io Tsuruoka , Kazunao Hayashi , Shuji Terai , K unio Iwatsuka , Keisuke Iwata , Motoyuki Yoshida , T omofumi Takagi , Manabu Goto , Noriko Oza , Y asuhito Takeda , Hideki Hagiwara , Toshihiro Tadano , Toshitaka Sakai , Kimi Sumimoto , Nauro Nishimura , Atsushi Irisawa , Masaki Kuwatani , Nakao Shirahata , Masahiro Satoh , Tomoaki Fujikawa , Yusuke Iizawa , Noriko Watanabe , H iroshi Ishiguro , Naoya Sawada , Kazuhiro Katada , Hiromu Kondo , Ichiro Sakakihara , J unji Nishida , Tetsuo Tamura , Naohiro Dairaku , Hidehiro Kamezaki , Hiroyuki Okano , Shuji Suzuki , Tomoyoshi Okamoto , Yasuhiro Matsugu , Mahiro Imamura , Mitsuyoshi Honjo , Gen Sugiyama , Hajime Ohta , Syunichi Higashide , Shuji Ishii , Tatsuya Hoshi , Yasuhiko Takagi , Akihiko Satoh , Naohisa Yamaji , Nauro Nishimura , Masayuki Shibasaki , Hiroyuki Tamura , Takuji Iwashita , Masayo Motoya , Yuki Tanisaka , Shomei Ryozawa , H ajime Takatori , Nanae Tsuruoka , S hinichi Hashimoto , Noriaki Suzuki , Yuichirou Sato , H ironao Tamai , Kazuo Hara , K iyoshi Ashida , T omoyuki Yokota , Tsuyotoshi Tsuji , Makoto Abue , Hiroaki Tomaki , Masanori Fukunishi , Hideaki Koga , Yusuke Takehara , H iroshi Kawamura , Naoto Shimokawahara , Naoya Otsu , Yasutoshi Kimura , Keinosuke Ishido , Yasuhide Kofunato , Masahiro Shiihara , T akanori Sakaguchi , Toshihiko Masui , Hidetoshi Eguchi , Kazuhiro Suzumura , Takao Ide , Masafumi Inomata , Kosei Maemura , Hajime Iizawa , A kio Nakajima , Shiro Uyama , Shigehiro Shiozaki , Sachio Yokoyama , T oshiki Wakabayashi , Takayuki Furuuchi , Toshifumi Gushima , S huichi Satoh , Takeshi Shioya , Kazunori Nakazawa , Yoshimitsu Takahashi , Nobuhiko Fukuba , Saburo Matsubara .

Funding

This work was supported in part by the Japan Pancreas Society, and Division of Gastroenterology, Tohoku University Graduate School of Medicine.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Atsushi Masamune, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada & Tooru Shimosegawa

  2. Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

    Ichiro Tsuji

  3. Department of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan

    Yoshifumi Takeyama

  4. Department of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Japan

    Kazuichi Okazaki

Authors
  1. Atsushi Masamune
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuhiro Kikuta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiyoshi Kume
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shin Hamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ichiro Tsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshifumi Takeyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tooru Shimosegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kazuichi Okazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the Japan Pancreas Society

  • Shin Miura
  • , Tetsuya Takikawa
  • , Seiji Hongo
  • , Eriko Nakano
  • , Tatsuhide Nabeshima
  • , Ryotaro Matsumoto
  • , Yu Tanaka
  • , Masayuki Ueno
  • , Tsuyoshi Mukai
  • , Masataka Matsumoto
  • , Yasushi Kudo
  • , Shunjiro Azuma
  • , Kosuke Okuwaki
  • , Satoshi Yamamoto
  • , Kazuo Inui
  • , Kasen Kobashigawa
  • , Jun Unno
  • , Nao Fujimori
  • , Katsuya Kitamura
  • , H iroyuki Miyakawa
  • , Kuniyuki Takahashi
  • , Tsukasa Ikeura
  • , Kazuichi Okazaki
  • , Mamoru Takenaka
  • , Mitsuharu Fukasawa
  • , Hiroyuki Funayama
  • , Akira Mitoro
  • , Tadayuki Takagi
  • , Masanari Sekine
  • , Kanetoshi Suwa
  • , Junichi Sakagami
  • , Masaharu Ishida
  • , Masayuki Ohtsuka
  • , S hingo Kagawa
  • , Takashi Muraki
  • , Takayuki Watanabe
  • , Takashi Watanabe
  • , Katsunori Yamamoto
  • , T omohiro Masaka
  • , Masatsugu Nagahama
  • , Ai Sato
  • , Yukio Aruga
  • , Yousuke Nakai
  • , Eisuke Iwasaki
  • , T akao Itoi
  • , Yuki Kawaji
  • , Masayuki Kitano
  • , Kazuhiro Mizukami
  • , Susumu Iwasaki
  • , Masashi Mori
  • , Naoya Kaneko
  • , Yuzo Kodama
  • , Hiroko Sato
  • , Naoki Yoshida
  • , Katsuko Hatayama
  • , Takashi Kobayashi
  • , Atsuyuki Hirano
  • , Miyuki Kaino
  • , Toshio Fujisawa
  • , Tomoyuki Ushijima
  • , Mitsuru Chiba
  • , K yoko Shimizu
  • , Hirotaka Ota
  • , Masao Toki
  • , Takao Nishikawa
  • , Yu Yoshida
  • , Kei Tanaka
  • , Kota Uetsuki
  • , Daisuke Motoya
  • , Shinichiro Muro
  • , Hiroyuki Watanabe
  • , Yoshiki Imamura
  • , Tetsuya Ishizawa
  • , Terumi Kamisawa
  • , M io Tsuruoka
  • , Kazunao Hayashi
  • , Shuji Terai
  • , K unio Iwatsuka
  • , Keisuke Iwata
  • , Motoyuki Yoshida
  • , T omofumi Takagi
  • , Manabu Goto
  • , Noriko Oza
  • , Y asuhito Takeda
  • , Hideki Hagiwara
  • , Toshihiro Tadano
  • , Toshitaka Sakai
  • , Kimi Sumimoto
  • , Nauro Nishimura
  • , Atsushi Irisawa
  • , Masaki Kuwatani
  • , Nakao Shirahata
  • , Masahiro Satoh
  • , Tomoaki Fujikawa
  • , Yusuke Iizawa
  • , Noriko Watanabe
  • , H iroshi Ishiguro
  • , Naoya Sawada
  • , Kazuhiro Katada
  • , Hiromu Kondo
  • , Ichiro Sakakihara
  • , J unji Nishida
  • , Tetsuo Tamura
  • , Naohiro Dairaku
  • , Hidehiro Kamezaki
  • , Hiroyuki Okano
  • , Shuji Suzuki
  • , Tomoyoshi Okamoto
  • , Yasuhiro Matsugu
  • , Mahiro Imamura
  • , Mitsuyoshi Honjo
  • , Gen Sugiyama
  • , Hajime Ohta
  • , Syunichi Higashide
  • , Shuji Ishii
  • , Tatsuya Hoshi
  • , Yasuhiko Takagi
  • , Akihiko Satoh
  • , Naohisa Yamaji
  • , Nauro Nishimura
  • , Masayuki Shibasaki
  • , Hiroyuki Tamura
  • , Takuji Iwashita
  • , Masayo Motoya
  • , Yuki Tanisaka
  • , Shomei Ryozawa
  • , H ajime Takatori
  • , Nanae Tsuruoka
  • , S hinichi Hashimoto
  • , Noriaki Suzuki
  • , Yuichirou Sato
  • , H ironao Tamai
  • , Kazuo Hara
  • , K iyoshi Ashida
  • , T omoyuki Yokota
  • , Tsuyotoshi Tsuji
  • , Makoto Abue
  • , Hiroaki Tomaki
  • , Masanori Fukunishi
  • , Hideaki Koga
  • , Yusuke Takehara
  • , H iroshi Kawamura
  • , Naoto Shimokawahara
  • , Naoya Otsu
  • , Yasutoshi Kimura
  • , Keinosuke Ishido
  • , Yasuhide Kofunato
  • , Masahiro Shiihara
  • , T akanori Sakaguchi
  • , Toshihiko Masui
  • , Hidetoshi Eguchi
  • , Kazuhiro Suzumura
  • , Takao Ide
  • , Masafumi Inomata
  • , Kosei Maemura
  • , Hajime Iizawa
  • , A kio Nakajima
  • , Shiro Uyama
  • , Shigehiro Shiozaki
  • , Sachio Yokoyama
  • , T oshiki Wakabayashi
  • , Takayuki Furuuchi
  • , Toshifumi Gushima
  • , S huichi Satoh
  • , Takeshi Shioya
  • , Kazunori Nakazawa
  • , Yoshimitsu Takahashi
  • , Nobuhiko Fukuba
  •  & Saburo Matsubara

Corresponding author

Correspondence to Atsushi Masamune.

Ethics declarations

Conflict of interest

Masamune A received a lecture fee from Mylan EPD.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

535_2020_1704_MOESM1_ESM.pdf

Supplementary file1 Supplementary Fig. 1. Schematic flowchart of the process for CP diagnosis. Definite CP is diagnosed by the presence of definite findings in items ① or ② or the presence of probable findings in ① or ② together with more than two items among ③ ~ ⑤. A diagnosis of early CP can be made if a patient does not satisfy a diagnosis of definite or probable CP but has at least three of five (③ ~ ⑦) clinical signs and imaging findings of early CP. If imaging findings of early CP were absent, a diagnosis of possible CP could be made after ruling out other diseases. CP, chronic pancreatitis; ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasonography; MRCP, magnetic resonance cholangiopancreatography. Supplementary Fig. 2. Trend of the estimated number of patients with CP in Japan. The estimated numbers of patients with CP in this and previous (references #4–8) surveys are shown. Supplementary Fig. 3. Distribution of age at disease onset in patients with CP according to sex. Supplementary Fig. 4. Age distribution of patients with early CP according to sex. (PDF 71 kb)

Supplementary file2 (DOCX 27 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Masamune, A., Kikuta, K., Kume, K. et al. Nationwide epidemiological survey of chronic pancreatitis in Japan: introduction and validation of the new Japanese diagnostic criteria 2019. J Gastroenterol 55, 1062–1071 (2020). https://doi.org/10.1007/s00535-020-01704-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-020-01704-9

Keywords

Search

Navigation