Mo1254 - Analysis of Chronic Pancreatitis in a Spanish Cohort (rippe Registry)

Background: Chronic pancreatitis (CP) is a complex disease.It results from the interaction of multiple aetiologies.The M-ANNHEIM classification is a multiple risk factor system validated for CP.It categorizes clinical presentation and assesses the severity of CP.However its use in clinical practice is uncommon.The Spanish Pancreatic Diseases Patients Registry (RIPPE) is a nationwide registry to better understand the natural history of pancreatic disorders.Objective: To evaluate M-ANNHEIM classification in the RIPPE CP cohort.Methods: CP patients recruited between October 2015 and October 2017 were included.A descriptive analysis of demographics and different aetiologies were performed.CP diagnostic criteria were adapted under recent guidelines.M-ANNHEIM clinical staging and severity index (according to clinical features), were calculated for RIPPE patients in a web-tool using a validated scoring system.Results: 145 patients, 82.8% men and 17.2% women (mean age 50.6 years (SD=13.4)).Charslon score 1.24 (SD=1.5).The main risk factors according M-Annheim were nicotine (53.1%) and alcohol consumption (24.3%); ex-drinkers (60,4%).A remarkable 58,3% of patients had a history of preceding Acute Pancreatitis (AP) and 36,8% of patients had Recurrent Acute Pancreatitis (RAP).Clinical stage was calculated in 121 patients: 93,85 % of patients presented advanced clinical stage but only 27,4% of PC shown an advanced or worse severity level (>10 points) in the Severity index (table 1).17.2% of patients showed moderate exocrine pancreatic insufficiency EPI (fecal elastase test <200mcg/gr) and 51% severe EPI (FE<100 mcg/gr).Endocrine insufficiency was recorded in 48% of patients.A statistically significant relation between history of previous acute pancreatitis and clinical stage was found (table 2): those patients with preceding RAP developed more frequently a clinical stage-III (p-value 0.005 Fisher test).Conclusion: Analysis of RIPPE under M-ANNHEIM classification demonstrates that individuals with similar clinical features can experiment different clinical presentations and grades of severity.CP in early stages is still underestimated.Many cases of CP are preceded by AP.History of recurrent acute pancreatitis predicts an advanced clinical stage II-III.Large prospective studies are needed.