Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis
Year: 2016
Type: article
Abstract: OBJECTIVES: Racial differences in susceptibility and progression of pancreatitis have been reported in epidemiologic studies using administrative or retrospective data. There has been little study, however, on the clinical profile, causes, and outcome of chronic pancreatitis (CP) in black patients. METHODS: We analyzed data on black patients with CP prospectively enrolled in the multicenter North American Pancreatitis Studies from 26 US centers during the years 2000-2014. CP was defined by definitive evidence on imaging studies or histology. Information on demographics, etiology, risk factors, disease phenotype, treatment, and perceived effectiveness was obtained from responses to detailed questionnaires completed by both patients and physicians. RESULTS: Of the 1,159 patients enrolled, 248 (21%) were black. When compared with whites, blacks were significantly more likely to be male (60.9 vs. 53%), ever (88.2 vs. 71.8%), or current smokers (64.2 vs. 45.9%), or have a physician-defined alcohol etiology (77 vs. 41.9%). There was no overall difference in the duration of CP although for alcoholic CP, blacks had a longer duration of disease (8.6 vs. 6.97 years; P=0.02). Blacks were also significantly more likely to have advanced changes on pancreatic morphology (calcifications (63.3 vs. 55.2%), atrophy (43.2 vs. 34.6%), pancreatic ductal stricture or dilatation (72.6 vs. 65.5%) or common bile duct stricture (18.6 vs. 8.2%)) and function (endocrine insufficiency 39.9 vs. 30.2%). Moreover, the prevalence of any (94.7 vs. 83%), constant (62.6 vs. 51%), and severe (78.4 vs. 65.8%) pain and disability (35.1 vs. 21.4%) were significantly higher in blacks. Observed differences were in part related to variances in etiology and duration of disease. No differences in medical or endoscopic treatments were seen between races although prior cholecystectomy (31.1 vs. 19%) was more common in white patients. CONCLUSIONS: Differences were observed between blacks and whites in the underlying cause, morphologic expression, and pain characteristics of CP, which in part are explained by the underlying risk factor(s) with alcohol and tobacco being much more frequent in black patients as well as disease duration.
DOI: 10.1038/ajg.2016.316
Authors: Mel C Wilcox, Bimaljit S Sandhu, Vikesh Singh, Andres Gelrud, Judah N Abberbock, Stuart Sherman, Gregory A Cote, Samer Al-Kaade, Michelle A Anderson, Timothy B Gardner, Michele D Lewis, Christopher E Forsmark, Nalini M Guda, Joseph Romagnuolo, John Baillie, Stephen T Amann, Thiruvengadam Muniraj, Gong Tang, Darwin L Conwell, Peter A Banks, Randall E Brand, Adam Slivka, David Whitcomb, Dhiraj Yadav
Institutions: University of Alabama at Birmingham, Virginia Commonwealth University, Johns Hopkins University, University of Pittsburgh, University of Chicago, University of Cincinnati, Indiana University School of Medicine, Medical University of South Carolina, Saint Louis University, University of Michigan, Dartmouth–Hitchcock Medical Center, Mayo Clinic, Mayo Clinic in Florida, University of Florida Health, University of Florida, Palmetto Health Richland, Duke Medical Center, North Mississippi Medical Center, Yale University, Brigham and Women's Hospital, The Ohio State University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2512420944