A 58-year-old man was admitted to our hospital with abdominal pain. He had a history of alcohol intake of >80 g a day for more than 30 years. His blood sugar was within normal limits, while his serum amylase and lipase were elevated. There was no history of steatorrhoea and the faecal fat excretion was within normal limits. Computerised tomography of the abdomen revealed the presence of small ill-defined calculi in the pancreatic ducts with speckled margins. Endoscopic retrograde cholangio-pancreatography showed mild ductal dilatation. With this clinical presentation and imaging characteristics, a diagnosis of alcoholic chronic pancreatitis (ACP) was made.

This is the spectrum of chronic pancreatitis patients I and my colleagues in gastroenterology are now seeing in India, which is in stark contrast to the chronic pancreatitis patients I saw as a trainee 25 years ago. Has the spectrum of chronic pancreatitis in India changed?

CHARACTERISTICS OF CHRONIC PANCREATITIS

Chronic pancreatitis is a condition characterised by irreversible destruction and fibrosis of the exocrine parenchyma, leading to exocrine pancreatic insufficiency and progressive endocrine failure resulting in diabetes. ACP is the most common type of chronic pancreatitis seen in the western world, while in tropical countries like India, tropical chronic pancreatitis (TCP) was once far more common.

TCP, a juvenile form of chronic calcific non-alcoholic pancreatitis and seen almost exclusively in the developing countries of the tropical world, has a characteristic presentation. Some of …