Unifying Concepts

Diagnostic Criteria for Chronic Pancreatitis

Chronic Pancreatitis (CP) is a debilitating disease that classically presents with recurrent bouts of acute pancreatitis, chronic abdominal pain as well as evidence of end organ damage. This is a result of extensive fibrosis and inflammation within the gland that eventually leads to both exocrine and endocrine insufficiency.

Major Classification Systems of Etiologies for Chronic Pancreatitis

Classification for CP Etiology

Traditional: Alcohol, idiopathic, hereditary, obstructive, hyperlipidemia


  • Toxic-metabolic: alcohol, tobacco smoking, hypercalcemia, hyperlipidemia, chronic renal failure, medications, toxins
  • Idiopathic: early onset, late onset, tropical
  • Genetic mutations: PRSS1, CFTR, SPINK1, others
  • Autoimmune: isolated, syndromic
  • Recurrent and severe AP-associated CP: postnecrotic (severe AP), vascular disease/ischemic, postirradiation
  • Obstructive: pancreas divisum, sphincter of Oddi disorders, duct obstruction (eg, tumor), posttraumatic pancreatic duct scars


  • M indicates multiple risk factors including:
  • Alcohol consumption: excessive (>80 g/d), increased (20–80 g/d), moderate (<20 g/d)
  • Nicotine consumption
  • Nutritional factors: high caloric proportion of fat and protein, hyperlipidemia
  • Hereditary factors: hereditary, familial, idiopathic (early onset, late onset), tropical
  • Efferent duct factors: pancreas divisum, annular pancreas and other congenital abnormalities of the pancreas, pancreatic duct obstruction (eg, tumors), posttraumatic pancreatic duct scars, sphincter of Oddi dysfunction
  • Immunological factors: autoimmune pancreatitis
  • Miscellaneous and rare metabolic disorders: hypercalcemia, hyperparathyroidism, chronic renal failure, drugs, toxins

M-ANNHEIM pancreatic imaging Criteria for Chronic Pancreatitis

Cambridge Grading CT, US, MRI/MRCP Endoscopic Ultrasound (EUS)
Normal Quality Study depicting whole gland without abnormal features (0 points)
Equivocal One abnormal feature (1 point) Four or fewer abnormal Features (no differentiation between equivocal and mild) (1 point) Five or more abnormal features (no differentiation between moderate and marked) (3 points)
Mild changes Two or more abnormal features, but normal main pancreatic duct
Moderate changes Two or more abnormal features, including minor main pancreatic duct abnormalities (either enlargement between 2 and 4 mm or increased echogenicity of the duct wall) (3 points)
Marked changes As above with one or more of the required features of marked changes (4 points)

* Abnormal Features: Main pancreatic duct enlargement (2–4 mm), slight gland enlargement (up to 2× normal), heterogeneous parenchyma, small cavities (10 mm), irregular ducts, focal acute pancreatitis, increased echogenicity of the main pancreatic duct wall, irregular head/body contour

** Marked Changes: Large cavities (>10 mm), gross gland enlargement (>2× normal), intraductal filling defects or calculi, duct obstruction, structure or gross irregularity, contiguous organ invasion

*** MRI, Magnetic resonance imaging; MRCP, magnetic resonance cholangiopancreatography



  1. Anaizi A, Hart PA, Conwell DL. Diagnosing Chronic Pancreatitis. Dig Dis Sci. 2017 Jul;62(7):1713-1720. [Medline]
  2. Issa Y, van Santvoort HC, van Dieren S, Besselink MG, Boermeester MA, Ahmed Ali U. Diagnosing Chronic Pancreatitis: Comparison and Evaluation of Different Diagnostic Tools. Pancreas. 2017 Oct;46(9):1158-1164. [Medline]
  3. Vege SS, Chari ST. Chronic Pancreatitis. N Engl J Med. 2022 Mar 3;386(9):869-878. [Medline]


Created Nov 02, 2022.


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