Clinical presentation of painless pancreatitis: a systematic review
1Department of Emergency Medicine, MacKay Memorial Hospital, Tamshui Branch, 251020 Tamshui, Taiwan
2Department of Emergency Medicine, MacKay Memorial Hospital, 10449 Taipei, Taiwan
3Department of Medicine, MacKay Medical College, 25245 New Taipei, Taiwan
4Toxicology Division, Department of Emergency Medicine, MacKay Memorial Hospital, 10449 Taipei, Taiwan
5MacKay Junior College of Medicine, Nursing, and Management, 11260 Taipei, Taiwan
6Yuanpei University of Medical Technology, 30015 HsinChu, Taiwan
Submitted: 09 May 2022 Accepted: 14 July 2022
Online publish date: 11 January 2023
Painless pancreatitis is a slowly developing syndrome that involves inflammation, scarring and thickening of pancreatic cells and is often difficult to clinically diagnose due to lack of pain and indolent course. Thus, to increase awareness of this disease and improve its diagnosis, we conducted this study to investigate the epidemiology, clinical presentation and outcomes of painless pancreatitis. This systematic review was designed to investigate the epidemiology, clinical course and presentation, cause and comorbidities of painless pancreatitis. The PubMed database was used to search for the following keywords: “Clinical presentation”, “painless pancreatitis” and “case report” until August 2021. The following data were collected: country, age, gender, alkaline phosphatase, total bilirubin, lipase, amylase, comorbidity of hypertension, diabetes mellitus, alcohol consumption, symptoms of malaise, jaundice, diarrhea, vomiting, surgical intervention, drain and analyzed statistically. There are 23 cases from 22 case reports enrolled into study. The mean age of the included patients was 44.7 ± 20.6 years old. Males accounted for 73.9% of all cases. The rate of a personal history of smoking and alcohol drinking was 46.2% and 31.6%. A history of hypertension and diabetes was observed in 8.7% and 17.4% of the cases. Fever was documented in 75% of cases. A significant and positive correlation was observed between biochemistry results, including amylase and lipase, total bilirubin and direct bilirubin, and painless pancreatitis (r = 0.571 and r = 0.193). Alkaline phosphatase and the victim’s age were negatively correlated with painless pancreatitis (r = −0.183, p = 0.042). In this study, we found that painless pancreatitis was predominant in males and presented mainly with fever, distended abdomen without pain. A personal history of smoking and alcohol drinking was observed in 46.2% and 31.6% of cases.
Amylase; Gender; Lipase; Painless; Pancreatitis
Nai-Hui Lin,Chun Chen,Hsiu-Wu Yang,Yu-Jang Su. Clinical presentation of painless pancreatitis: a systematic review. Signa Vitae. 2023.doi:10.22514/sv.2023.001.
 Gambill EE, Pugh DG. Pancreatic calcification; study of clinical and roentgenologic data on 39 cases. Archives of Internal Medicine. 1948; 81: 301–315.
 Pham A, Forsmark C. Chronic pancreatitis: review and update of etiology, risk factors, and management. F1000Research. 2018; 7: F1000.
 Lankisch PG, Löhr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion. 1993; 54: 148–155.
 Amodio A, De Marchi G, de Pretis N, Crinò SF, D’Onofrio M, Gabbrielli A, et al. Painless chronic pancreatitis. Digestive and Liver Disease. 2020; 52: 1333–1337.
 Kamisawa T, Yoshiike M, Egawa N, Nakajima H, Tsuruta K, Okamoto A, et al. Chronic pancreatitis in the elderly in Japan. Pancreatology. 2004; 4: 223–227.
 Bhullar FA, Faghih M, Akshintala VS, Ahmed AI, Lobner K, Afghani, et al. Corrigendum to “prevalence of primary painless chronic pancreatitis: a systematic review and meta-analysis”. Pancreatology. 2022; 22: 448.
 Majumder S, Chari ST. Chronic pancreatitis. The Lancet. 2016; 387: 1957–1966.
 Ammann RW. Idiopathic “senile” chronic pancreatitis and pancreatic lithiasis in the aged. Gastroenterology. 1984; 87: 253.
 Herfort K, Kecklík M, Sivanová Z. Painless chronic pancreatitis. Gastroenterologia. 1967; 108: 169–176.
 Goulston SJM, Gallagher ND. Chronic painless pancreatitis. Gut. 1962; 3: 252–254.
 Chatila AT, Bilal M, Guturu P. Evaluation and management of acute pancreatitis. World Journal of Clinical Cases. 2019; 7: 1006–1020.
 Popa CC, Badiu DC, Rusu OC, Grigorean VT, Neagu SI, Strugaru CR. Mortality prognostic factors in acute pancreatitis. Journal of Medicine and Life. 2016; 9: 413–418.
 Fong WWS, Thumboo J, Azhar R, Yoong JKC. IgG4-related disease in Singapore: a description of two cases and review of the literature. International Journal of Rheumatic Diseases. 2013; 16: 93–97.
 Kim J, Chang JH, Nam SM, Lee MJ, Maeng IH, Park JY, et al. Newly developed autoimmune cholangitis without relapse of autoimmune pancreatitis after discontinuing prednisolone. World Journal of Gastroenterology. 2012; 18: 5990–5993.
 Agarwal MP, Giri S, Gandhi V, Sharma A, Gupta R, Sharma V. Education and imaging. Gastrointestinal: a cutaneous clue to painless acute on chronic pancreatitis. Journal of Gastroenterology and Hepatology. 2012; 27: 842.
 Pezzilli R, Cariani G. Painless jaundice: remember alcohol and smoking habits for the diagnosis. Gastroenterology. 2009; 137: e3–e4.
 Rao SS, Riley SA, Foster PN, Losowsky MS, Stone WD. Hereditary pancreatitis presenting with ascites. Postgraduate Medical Journal. 1986; 62: 873–875.
 Buchta RM, Bell L. Chronic fibrosing pancreatitis in a 12-year-old female. Journal of Adolescent Health. 1991; 12: 395–397.
 Sutton PA, Humes DJ, Purcell G, Smith JK, Whiting F, Wright T, et al. The role of routine assays of serum amylase and lipase for the diagnosis of acute abdominal pain. Annals of the Royal College of Surgeons of England. 2009; 91: 381–384.
 Ismail OZ, Bhayana V. Lipase or amylase for the diagnosis of acute pancreatitis? Clinical Biochemistry. 2017; 50: 1275–1280.
 Siest G. Interpretation of clinical laboratory tests: reference values and their biological variation. Biomedical Publications: 1985.
 Güngör B, Cağlayan K, Polat C, Seren D, Erzurumlu K, Malazgirt Z. The predictivity of serum biochemical markers in acute biliary pancreatitis. ISRN Gastroenterology. 2011; 2011: 279607.
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