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Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis.
Am J Gastroenterol 2016; 111(10):1488-1496AJ

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.

Authors+Show Affiliations

University of Alabama at Birmingham, Birmingham, Alabama, USA.Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.University of Chicago, Chicago, Illinois, USA.University of Pittsburgh, Pittsburgh, Pennsylvania, USA.Indiana University School of Medicine, Indianapolis, Indiana, USA.Indiana University School of Medicine, Indianapolis, Indiana, USA.Saint Louis University School of Medicine, St Louis, Missouri, USA.University of Michigan School of Medicine, Ann Arbor, Michigan, USA.Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.Mayo Clinic, Jacksonville, Florida, USA.University of Florida College of Medicine, Gainesville, Florida, USA.University of Wisconsin School of Medicine, Milwaukee, Wisconsin, USA.Medical University of South Carolina, Charleston, South Carolina, USA.Duke University Medical Center, Durham, North Carolina, USA.North Mississippi Medical Center, Tupelo, Mississippi, USA.Yale University, New Haven, Connecticut, USA.University of Pittsburgh, Pittsburgh, Pennsylvania, USA.Brigham and Women's Hospital, Boston, Massachusetts, USA.Brigham and Women's Hospital, Boston, Massachusetts, USA.Evanston Northwestern Healthcare, Chicago, Illinois, USA.University of Pittsburgh, Pittsburgh, Pennsylvania, USA.University of Pittsburgh, Pittsburgh, Pennsylvania, USA.University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27527745

Citation

Wilcox, C Mel, et al. "Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis." The American Journal of Gastroenterology, vol. 111, no. 10, 2016, pp. 1488-1496.
Wilcox CM, Sandhu BS, Singh V, et al. Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis. Am J Gastroenterol. 2016;111(10):1488-1496.
Wilcox, C. M., Sandhu, B. S., Singh, V., Gelrud, A., Abberbock, J. N., Sherman, S., ... Yadav, D. (2016). Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis. The American Journal of Gastroenterology, 111(10), pp. 1488-1496. doi:10.1038/ajg.2016.316.
Wilcox CM, et al. Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis. Am J Gastroenterol. 2016;111(10):1488-1496. PubMed PMID: 27527745.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis. AU - Wilcox,C Mel, AU - Sandhu,Bimaljit S, AU - Singh,Vikesh, AU - Gelrud,Andres, AU - Abberbock,Judah N, AU - Sherman,Stuart, AU - Cote,Gregory A, AU - Al-Kaade,Samer, AU - Anderson,Michelle A, AU - Gardner,Timothy B, AU - Lewis,Michele D, AU - Forsmark,Christopher E, AU - Guda,Nalini M, AU - Romagnuolo,Joseph, AU - Baillie,John, AU - Amann,Stephen T, AU - Muniraj,Thiruvengadam, AU - Tang,Gong, AU - Conwell,Darwin L, AU - Banks,Peter A, AU - Brand,Randall E, AU - Slivka,Adam, AU - Whitcomb,David, AU - Yadav,Dhiraj, Y1 - 2016/08/16/ PY - 2016/01/01/received PY - 2016/07/05/accepted PY - 2016/8/17/pubmed PY - 2019/3/21/medline PY - 2016/8/17/entrez SP - 1488 EP - 1496 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 111 IS - 10 N2 - 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. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/27527745/Racial_Differences_in_the_Clinical_Profile_Causes_and_Outcome_of_Chronic_Pancreatitis_ L2 - http://Insights.ovid.com/pubmed?pmid=27527745 DB - PRIME DP - Unbound Medicine ER -