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J Gastroenterol 2007; 42:101119 DOI 10.1007/s00535-006-1945-4
The M-ANNHEIM classication of chronic pancreatitis: introduction of a unifying classication system based on a review of previous classications of the disease
Alexander Schneider, J. Matthias Lhr, and Manfred V. Singer
Department of Medicine II, Medical Faculty at Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, D-68135 Mannheim, Germany
Background. Several classication systems of chronic pancreatitis have been proposed to provide a basis for treatment and research. All of these previous classications were designed at the height of pancreatic research of their respective times; thus, each represented the most current knowledge available to pancreatologists at the time. However, none of these classications provide simultaneously a simple standardized system for the clinical classication of chronic pancreatitis according to etiology, clinical stage, and severity of the disease, nor are they consistently useful for directing clinical practice and comparing interinstitutional data. Thus, we aimed to develop a new classication system of chronic pancreatitis to provide a framework for studying the interaction of various risk factors on the course of the disease. Methods. We reviewed the literature on the clinical course of all different forms of chronic pancreatitis, and we reviewed all previous classication systems of the disease. This approach provided a basis for the development of a new and unifying classication of chronic pancreatitis. Results. We established the MANNHEIM multiple risk factor classication system based on the current knowledge of acute and chronic pancreatitis. This classication allows patients to be categorized according to the etiology, clinical stage, and severity of their disease. The severity of pancreatic inammation was assessed using a scoring system that takes into account the clinical symptoms and treatment options of chronic pancreatitis. Finally, four hypothetical patients were categorized according to the M-
ANNHEIM classication system to provide examples of its applicability in clinical practice. Conclusions. The M-ANNHEIM multiple risk factor classication system is simple, objective, accurate, and relatively noninvasive, and it incorporates etiology, different stages of the disease, and various degrees of clinical severity. This new classication system will be helpful for investigating the impact and interaction of various risk factors on the course of the disease and will facilitate the comparison and combination of interinstitutional data.
Key words: chronic pancreatitis, classication, CFTR, SPINK1, PRSS1, alcoholic pancreatitis
Introduction