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. 2003 Nov;79(937):606–615. doi: 10.1136/pmj.79.937.606

Tropical chronic pancreatitis

K Barman 1, G Premalatha 1, V Mohan 1
PMCID: PMC1742869  PMID: 14654569

Abstract

Tropical chronic pancreatitis (TCP) is a juvenile form of chronic calcific non-alcoholic pancreatitis, seen almost exclusively in the developing countries of the tropical world. The classical triad of TCP consists of abdominal pain, steatorrhoea, and diabetes. When diabetes is present, the condition is called fibrocalculous pancreatic diabetes (FCPD) which is thus a later stage of TCP. Some of the distinctive features of TCP are younger age at onset, presence of large intraductal calculi, more aggressive course of the disease, and a high susceptibility to pancreatic cancer. Pancreatic calculi are the hallmark for the diagnosis of TCP and in non-calcific cases ductal dilation on endoscopic retrograde cholangiopancreatography, computed tomography, or ultrasound helps to identify the disease. Diabetes is usually quite severe and of the insulin requiring type, but ketosis is rare. Microvascular complications of diabetes occur as frequently as in type 2 diabetes but macrovascular complications are uncommon. Pancreatic enzyme supplements are used for relief of abdominal pain and reducing the symptoms related to steatorrhoea. Early diagnosis and better control of the endocrine and exocrine dysfunction could help to ensure better survival and improve the prognosis and quality of life of TCP patients.

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Selected References

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  1. Abu-Bakare A., Taylor R., Gill G. V., Alberti K. G. Tropical or malnutrition-related diabetes: a real syndrome? Lancet. 1986 May 17;1(8490):1135–1138. doi: 10.1016/s0140-6736(86)91846-5. [DOI] [PubMed] [Google Scholar]
  2. Alberti K. G., Zimmet P. Z. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998 Jul;15(7):539–553. doi: 10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S. [DOI] [PubMed] [Google Scholar]
  3. Augustine P., Ramesh H. Is tropical pancreatitis premalignant? Am J Gastroenterol. 1992 Aug;87(8):1005–1008. [PubMed] [Google Scholar]
  4. Balaji L. N., Tandon R. K., Tandon B. N., Banks P. A. Prevalence and clinical features of chronic pancreatitis in southern India. Int J Pancreatol. 1994 Feb;15(1):29–34. doi: 10.1007/BF02924385. [DOI] [PubMed] [Google Scholar]
  5. Balakrishnan V. Chronic calcific pancreatitis in the tropics. Indian J Gastroenterol. 1984 Apr;3(2):65–67. [PubMed] [Google Scholar]
  6. Balakrishnan V., Hariharan M., Rao V. R., Anand B. S. Endoscopic pancreatography in chronic pancreatitis of the tropics. Digestion. 1985;32(2):128–131. doi: 10.1159/000199229. [DOI] [PubMed] [Google Scholar]
  7. Balakrishnan V., Sauniere J. F., Hariharan M., Sarles H. Diet, pancreatic function, and chronic pancreatitis in south India and France. Pancreas. 1988;3(1):30–35. doi: 10.1097/00006676-198802000-00006. [DOI] [PubMed] [Google Scholar]
  8. Bhatia Eesh, Choudhuri Gourdas, Sikora Sadiq S., Landt Olfert, Kage Andreas, Becker Michael, Witt Heiko. Tropical calcific pancreatitis: strong association with SPINK1 trypsin inhibitor mutations. Gastroenterology. 2002 Oct;123(4):1020–1025. doi: 10.1053/gast.2002.36028. [DOI] [PubMed] [Google Scholar]
  9. Boonyasrisawat Watip, Pulsawat Pinya, Yenchitsomanus Pa-Thai, Vannasaeng Sathit, Pramukkul Pakom, Deerochanawong Chaicharn, Sriussadaporn Sutin, Ploybutr Sirirat, Pasurakul Thawatchai, Banchuin Napatawn. Analysis of the reg1alpha and reg1beta gene transcripts in patients with fibrocalculous pancreatopathy. Southeast Asian J Trop Med Public Health. 2002 Jun;33(2):365–372. [PubMed] [Google Scholar]
  10. Braganza J. M. A framework for the aetiogenesis of chronic pancreatitis. Digestion. 1998;59 (Suppl 4):1–12. doi: 10.1159/000051438. [DOI] [PubMed] [Google Scholar]
  11. Braganza J. M., Schofield D., Snehalatha C., Mohan V. Micronutrient antioxidant status in tropical compared with temperate-zone chronic pancreatitis. Scand J Gastroenterol. 1993 Dec;28(12):1098–1104. doi: 10.3109/00365529309098316. [DOI] [PubMed] [Google Scholar]
  12. Chaloner C., Sandle L. N., Mohan V., Snehalatha C., Viswanathan M., Braganza J. M. Evidence for induction of cytochrome P-450I in patients with tropical chronic pancreatitis. Int J Clin Pharmacol Ther Toxicol. 1990 Jun;28(6):235–240. [PubMed] [Google Scholar]
  13. Chandak G. R., Idris M. M., Reddy D. N., Bhaskar S., Sriram P. V. J., Singh L. Mutations in the pancreatic secretory trypsin inhibitor gene (PSTI/SPINK1) rather than the cationic trypsinogen gene (PRSS1) are significantly associated with tropical calcific pancreatitis. J Med Genet. 2002 May;39(5):347–351. doi: 10.1136/jmg.39.5.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Chari S. T., Mohan V., Jayanthi V., Snehalatha C., Malathi S., Viswanathan M., Madanagopalan N. Comparative study of the clinical profiles of alcoholic chronic pancreatitis and tropical chronic pancreatitis in Tamil Nadu, south India. Pancreas. 1992;7(1):52–58. doi: 10.1097/00006676-199201000-00009. [DOI] [PubMed] [Google Scholar]
  15. Chari S. T., Mohan V., Pitchumoni C. S., Viswanathan M., Madanagopalan N., Lowenfels A. B. Risk of pancreatic carcinoma in tropical calcifying pancreatitis: an epidemiologic study. Pancreas. 1994 Jan;9(1):62–66. doi: 10.1097/00006676-199401000-00009. [DOI] [PubMed] [Google Scholar]
  16. Chari S., Jayanthi V., Mohan V., Malathi S., Madanagopalan N., Viswanathan M. Radiological appearance of pancreatic calculi in tropical versus alcoholic chronic pancreatitis. J Gastroenterol Hepatol. 1992 Jan-Feb;7(1):42–44. doi: 10.1111/j.1440-1746.1992.tb00932.x. [DOI] [PubMed] [Google Scholar]
  17. Chattopadhyaya P. S., Mukhopadhyay J., Chattopadhyay R., Gupta S. Macrovascular disease is not that uncommon in fibrocalculous pancreatic diabetes. Diabetes Care. 1994 May;17(5):462–463. doi: 10.2337/diacare.17.5.462b. [DOI] [PubMed] [Google Scholar]
  18. Gagee P., Pemberton P., Lobley R., Chaloner C., Snehalatha C., Mohan V., Braganza J. M. The BT-PABA/PAS test in tropical diabetes. Clin Chim Acta. 1992 Nov 30;212(3):103–111. doi: 10.1016/0009-8981(92)90177-r. [DOI] [PubMed] [Google Scholar]
  19. Geevarghese P. J., Pitchumoni C. S., Nair S. R. Is protein malnutrition an initiating cause of pancreatic calcification? J Assoc Physicians India. 1969 Jul;17(7):417–419. [PubMed] [Google Scholar]
  20. Govindarajan M., Mohan V., Deepa R., Ashok S., Pitchumoni C. S. Histopathology and immunohistochemistry of pancreatic islets in fibrocalculous pancreatic diabetes. Diabetes Res Clin Pract. 2001 Jan;51(1):29–38. doi: 10.1016/s0168-8227(00)00204-7. [DOI] [PubMed] [Google Scholar]
  21. Halgreen H., Pedersen N. T., Worning H. Symptomatic effect of pancreatic enzyme therapy in patients with chronic pancreatitis. Scand J Gastroenterol. 1986 Jan;21(1):104–108. doi: 10.3109/00365528609034631. [DOI] [PubMed] [Google Scholar]
  22. Hassan Z., Mohan V., McDermott M. F., Ali L., Ogunkolade W. B., Aganna E., Cassell P. G., Deepa R., Khan A. K., Hitman G. A. Pancreatitis in fibrocalculous pancreatic diabetes mellitus is not associated with common mutations in the trypsinogen gene. Diabetes Metab Res Rev. 2000 Nov-Dec;16(6):454–457. doi: 10.1002/1520-7560(2000)9999:9999<::aid-dmrr155>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  23. Hassan Zahid, Mohan Viswananthan, Ali Liaquat, Allotey Rebecca, Barakat Khalid, Faruque M. Omar, Deepa Raj, McDermott Michael F., Jackson Alan E., Cassell Paul. SPINK1 is a susceptibility gene for fibrocalculous pancreatic diabetes in subjects from the Indian subcontinent. Am J Hum Genet. 2002 Aug 16;71(4):964–968. doi: 10.1086/342731. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Hawrami K., Mohan V., Bone A., Hitman G. A. Analysis of islet regenerating (reg) gene polymorphisms in fibrocalculous pancreatic diabetes. Pancreas. 1997 Mar;14(2):122–125. doi: 10.1097/00006676-199703000-00003. [DOI] [PubMed] [Google Scholar]
  25. Kamalu B. P. The effect of a nutritionally-balanced cassava (Manihot esculenta Crantz) diet on endocrine function using the dog as a model. 1. Pancreas. Br J Nutr. 1991 May;65(3):365–372. doi: 10.1079/bjn19910097. [DOI] [PubMed] [Google Scholar]
  26. Kambo P. K., Hitman G. A., Mohan V., Ramachandran A., Snehalatha C., Suresh S., Metcalfe K., Ryait B. K., Viswanathan M. The genetic predisposition to fibrocalculous pancreatic diabetes. Diabetologia. 1989 Jan;32(1):45–51. doi: 10.1007/BF00265403. [DOI] [PubMed] [Google Scholar]
  27. Khan A. A., Ali L. Tropical calcific pancreatitis and fibrocalculus pancreatic diabetes in Bangladesh. J Gastroenterol Hepatol. 1997 Jun;12(6):S48–S52. doi: 10.1111/j.1440-1746.1997.tb00458.x. [DOI] [PubMed] [Google Scholar]
  28. Krawisz B. R., Miller L. J., DiMagno E. P., Go V. L. In the absence of nutrients, pancreatic-biliary secretions in the jejunum do not exert feedback control of human pancreatic or gastric function. J Lab Clin Med. 1980 Jan;95(1):13–18. [PubMed] [Google Scholar]
  29. Levitt N. S., Adams G., Salmon J., Marks I. N., Musson G., Swanepoel C., Levy M., Byrne M. J. The prevalence and severity of microvascular complications in pancreatic diabetes and IDDM. Diabetes Care. 1995 Jul;18(7):971–974. doi: 10.2337/diacare.18.7.971. [DOI] [PubMed] [Google Scholar]
  30. Lowenfels A. B., Maisonneuve P., Cavallini G., Ammann R. W., Lankisch P. G., Andersen J. R., Dimagno E. P., Andrén-Sandberg A., Domellöf L. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med. 1993 May 20;328(20):1433–1437. doi: 10.1056/NEJM199305203282001. [DOI] [PubMed] [Google Scholar]
  31. Lowenfels A. B., Maisonneuve P., DiMagno E. P., Elitsur Y., Gates L. K., Jr, Perrault J., Whitcomb D. C. Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group. J Natl Cancer Inst. 1997 Mar 19;89(6):442–446. doi: 10.1093/jnci/89.6.442. [DOI] [PubMed] [Google Scholar]
  32. Maisonneuve Patrick, Lowenfels Albert B. Chronic pancreatitis and pancreatic cancer. Dig Dis. 2002;20(1):32–37. doi: 10.1159/000063165. [DOI] [PubMed] [Google Scholar]
  33. Malesci A., Gaia E., Fioretta A., Bocchia P., Ciravegna G., Cantor P., Vantini I. No effect of long-term treatment with pancreatic extract on recurrent abdominal pain in patients with chronic pancreatitis. Scand J Gastroenterol. 1995 Apr;30(4):392–398. doi: 10.3109/00365529509093296. [DOI] [PubMed] [Google Scholar]
  34. Mathangi D. C., Deepa R., Mohan V., Govindarajan M., Namasivayam A. Long-term ingestion of cassava (tapioca) does not produce diabetes or pancreatitis in the rat model. Int J Pancreatol. 2000 Jun;27(3):203–208. doi: 10.1385/IJGC:27:3:203. [DOI] [PubMed] [Google Scholar]
  35. McMillan D. E., Geevarghese P. J. Dietary cyanide and tropical malnutrition diabetes. Diabetes Care. 1979 Mar-Apr;2(2):202–208. doi: 10.2337/diacare.2.2.202. [DOI] [PubMed] [Google Scholar]
  36. Mehrotra R. N., Bhatia E., Choudhuri G. Beta-cell function and insulin sensitivity in tropical calcific pancreatitis from north India. Metabolism. 1997 Apr;46(4):441–444. doi: 10.1016/s0026-0495(97)90063-9. [DOI] [PubMed] [Google Scholar]
  37. Mittal N., Mehrotra R., Agarwal G., Rajeswari, Choudhuri G., Sikora S., Bhatia E. The clinical spectrum of fibrocalculous pancreatic diabetes in north India. Natl Med J India. 2002 Nov-Dec;15(6):327–331. [PubMed] [Google Scholar]
  38. Mohan R., Rajendran B., Mohan V., Ramachandran A., Viswanathan M., Kohner E. M. Retinopathy in tropical pancreatic diabetes. Arch Ophthalmol. 1985 Oct;103(10):1487–1489. doi: 10.1001/archopht.1985.01050100063020. [DOI] [PubMed] [Google Scholar]
  39. Mohan V., Chari S. T., Hitman G. A., Suresh S., Madanagopalan N., Ramachandran A., Viswanathan M. Familial aggregation in tropical fibrocalculous pancreatic diabetes. Pancreas. 1989;4(6):690–693. doi: 10.1097/00006676-198912000-00006. [DOI] [PubMed] [Google Scholar]
  40. Mohan V., Chari S., Ramachandran A., Jayanthi V., Malathi S., Madanagopalan N., Viswanathan M. Fibrocalculous pancreatic diabetes and obesity. Diabetes Res Clin Pract. 1990 Jan;8(2):161–166. doi: 10.1016/0168-8227(90)90027-q. [DOI] [PubMed] [Google Scholar]
  41. Mohan V., Mohan R., Susheela L., Snehalatha C., Bharani G., Mahajan V. K., Ramachandran A., Viswanathan M., Kohner E. M. Tropical pancreatic diabetes in South India: heterogeneity in clinical and biochemical profile. Diabetologia. 1985 Apr;28(4):229–232. doi: 10.1007/BF00282238. [DOI] [PubMed] [Google Scholar]
  42. Mohan V., Mohan R., Susheela L., Snehalatha C., Bharani G., Mahajan V. K., Ramachandran A., Viswanathan M., Kohner E. M. Tropical pancreatic diabetes in South India: heterogeneity in clinical and biochemical profile. Diabetologia. 1985 Apr;28(4):229–232. doi: 10.1007/BF00282238. [DOI] [PubMed] [Google Scholar]
  43. Mohan V., Nagalotimath S. J., Yajnik C. S., Tripathy B. B. Fibrocalculous pancreatic diabetes. Diabetes Metab Rev. 1998 Jun;14(2):153–170. doi: 10.1002/(sici)1099-0895(199806)14:2<153::aid-dmr212>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  44. Mohan V., Nagalotimath S. J., Yajnik C. S., Tripathy B. B. Fibrocalculous pancreatic diabetes. Diabetes Metab Rev. 1998 Jun;14(2):153–170. doi: 10.1002/(sici)1099-0895(199806)14:2<153::aid-dmr212>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  45. Mohan V., Poongothai S., Pitchumoni C. S. Oral pancreatic enzyme therapy in the control of diabetes mellitus in tropical calculous pancreatitis. Int J Pancreatol. 1998 Aug;24(1):19–22. doi: 10.1007/BF02787526. [DOI] [PubMed] [Google Scholar]
  46. Mohan V., Premalatha G., Padma A., Chari S. T., Pitchumoni C. S. Fibrocalculous pancreatic diabetes. Long-term survival analysis. Diabetes Care. 1996 Nov;19(11):1274–1278. doi: 10.2337/diacare.19.11.1274. [DOI] [PubMed] [Google Scholar]
  47. Mohan V., Premalatha G., Sastry N. G. Peripheral vascular disease in non-insulin-dependent diabetes mellitus in south India. Diabetes Res Clin Pract. 1995 Mar;27(3):235–240. doi: 10.1016/0168-8227(95)01048-i. [DOI] [PubMed] [Google Scholar]
  48. Mohan V., Ramachandran A., Vijay Kumar G., Snehalatha C., Viswanathan M. Insulin resistance in Fibrocalculous (tropical) pancreatic diabetes. Horm Metab Res. 1988 Dec;20(12):746–748. doi: 10.1055/s-2007-1010937. [DOI] [PubMed] [Google Scholar]
  49. Mohan V., Ramachandran A., Viswanathan M. Two case reports of macrovascular complications in fibrocalculous pancreatic diabetes. Acta Diabetol Lat. 1989 Oct-Dec;26(4):345–349. doi: 10.1007/BF02624647. [DOI] [PubMed] [Google Scholar]
  50. Mohan V., Sastry N. G., Premalatha G. Autonomic dysfunction in non-insulin-dependent diabetes mellitus and fibrocalculous pancreatic diabetes in south India. Diabet Med. 1996 Dec;13(12):1038–1043. doi: 10.1002/(SICI)1096-9136(199612)13:12<1038::AID-DIA276>3.0.CO;2-G. [DOI] [PubMed] [Google Scholar]
  51. Mohan V., Snehalatha C., Ahmed M. R., Madanagopalan N., Chari S., Jayanthi V., Malathi S., Ramachandran A., Viswanathan M. Exocrine pancreatic function in tropical fibrocalculous pancreatic diabetes. Diabetes Care. 1989 Feb;12(2):145–147. doi: 10.2337/diacare.12.2.145. [DOI] [PubMed] [Google Scholar]
  52. Mohan V., Snehalatha C., Chari S. T., Bhattacharyya P. K., Madanagopalan N., Viswanathan M. Clinical and biochemical studies in the prediabetic phase of tropical calcific pancreatitis. Pancreas. 1992;7(1):109–113. doi: 10.1097/00006676-199201000-00015. [DOI] [PubMed] [Google Scholar]
  53. Mohan V., Snehalatha C., Ramachandran A., Chari S., Madanagopalan N., Viswanathan M. Plasma glucagon responses in tropical fibrocalculous pancreatic diabetes. Diabetes Res Clin Pract. 1990 Apr;9(1):97–101. doi: 10.1016/0168-8227(90)90015-l. [DOI] [PubMed] [Google Scholar]
  54. Mohan V., Snehalatha C., Ramachandran A., Jayashree R., Viswanathan M. Pancreatic beta-cell function in tropical pancreatic diabetes. Metabolism. 1983 Dec;32(12):1091–1092. doi: 10.1016/0026-0495(83)90053-7. [DOI] [PubMed] [Google Scholar]
  55. Mohan V., Sreeram D., Ramachandran A., Viswanathan M., Iyer Doraiswamy K. R. Ultrasonographic evaluation of the pancreas in tropical pancreatic diabetes. Acta Diabetol Lat. 1985 Apr-Jun;22(2):143–148. doi: 10.1007/BF02590788. [DOI] [PubMed] [Google Scholar]
  56. Mohan V., Suresh S., Suresh I., Ramachandran A., Ramakrishnan S., Snehalatha C., Viswanathan M. Fibrocalculous pancreatic diabetes in the elderly. J Assoc Physicians India. 1989 May;37(5):342–344. [PubMed] [Google Scholar]
  57. Mössner J., Secknus R., Meyer J., Niederau C., Adler G. Treatment of pain with pancreatic extracts in chronic pancreatitis: results of a prospective placebo-controlled multicenter trial. Digestion. 1992;53(1-2):54–66. doi: 10.1159/000200971. [DOI] [PubMed] [Google Scholar]
  58. Mössner J., Wresky H. P., Kestel W., Zeeh J., Regner U., Fischbach W. Influence of treatment with pancreatic extracts on pancreatic enzyme secretion. Gut. 1989 Aug;30(8):1143–1149. doi: 10.1136/gut.30.8.1143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Owyang C., Louie D. S., Tatum D. Feedback regulation of pancreatic enzyme secretion. Suppression of cholecystokinin release by trypsin. J Clin Invest. 1986 Jun;77(6):2042–2047. doi: 10.1172/JCI112534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Pfützer R. H., Barmada M. M., Brunskill A. P., Finch R., Hart P. S., Neoptolemos J., Furey W. F., Whitcomb D. C. SPINK1/PSTI polymorphisms act as disease modifiers in familial and idiopathic chronic pancreatitis. Gastroenterology. 2000 Sep;119(3):615–623. doi: 10.1053/gast.2000.18017. [DOI] [PubMed] [Google Scholar]
  61. Pitchumoni C. S. Special problems of tropical pancreatitis. Clin Gastroenterol. 1984 Sep;13(3):941–959. [PubMed] [Google Scholar]
  62. Pitchumoni C. S. Special problems of tropical pancreatitis. Clin Gastroenterol. 1984 Sep;13(3):941–959. [PubMed] [Google Scholar]
  63. Pitchumoni C. S., Viswanathan K. V., Gee Varghese P. J., Banks P. A. Ultrastructure and elemental composition of human pancreatic calculi. Pancreas. 1987;2(2):152–158. doi: 10.1097/00006676-198703000-00005. [DOI] [PubMed] [Google Scholar]
  64. Premalatha G., Mohan V. Fibrocalculous pancreatic diabetes in infancy--two case reports. Diabetes Res Clin Pract. 1994 Sep;25(2):137–140. doi: 10.1016/0168-8227(94)90039-6. [DOI] [PubMed] [Google Scholar]
  65. Punnose J., Balakrishnan V., Bhadran A., Das K. V. Exocrine pancreatic function in chronic pancreatitis with and without calcification. Indian J Gastroenterol. 1987 Apr;6(2):85–86. [PubMed] [Google Scholar]
  66. Ramachandran A., Mohan V., Kumaravel T. S., Velmurugendran C. U., Snehalatha C., Chinnikrishnudu M., Viswanathan M. Peripheral neuropathy in tropical pancreatic diabetes. Acta Diabetol Lat. 1986 Apr-Jun;23(2):135–140. doi: 10.1007/BF02624673. [DOI] [PubMed] [Google Scholar]
  67. Rao R. H. The role of undernutrition in the pathogenesis of diabetes mellitus. Diabetes Care. 1984 Nov-Dec;7(6):595–601. doi: 10.2337/diacare.7.6.595. [DOI] [PubMed] [Google Scholar]
  68. Rao R. H., Yajnik C. S. Commentary: time to rethink malnutrition and diabetes in the tropics. Diabetes Care. 1996 Sep;19(9):1014–1017. doi: 10.2337/diacare.19.9.1014. [DOI] [PubMed] [Google Scholar]
  69. Riela A., Zinsmeister A. R., Melton L. J., 3rd, Weiland L. H., DiMagno E. P. Increasing incidence of pancreatic cancer among women in Olmsted County, Minnesota, 1940 through 1988. Mayo Clin Proc. 1992 Sep;67(9):839–845. doi: 10.1016/s0025-6196(12)60821-0. [DOI] [PubMed] [Google Scholar]
  70. Robles-Díaz G., Vargas F., Uscanga L., Fernández-del Castillo C. Chronic pancreatitis in Mexico City. Pancreas. 1990 Jul;5(4):479–483. doi: 10.1097/00006676-199007000-00017. [DOI] [PubMed] [Google Scholar]
  71. Rossi L., Pfützer R. H., Parvin S., Ali L., Sattar S., Kahn A. K., Gyr N., Whitcomb D. C. SPINK1/PSTI mutations are associated with tropical pancreatitis in Bangladesh. A preliminary report. Pancreatology. 2001;1(3):242–245. doi: 10.1159/000055818. [DOI] [PubMed] [Google Scholar]
  72. SHAPER A. G. Chronic pancreatic disease and protein malnutrition. Lancet. 1960 Jun 4;1(7136):1223–1224. doi: 10.1016/s0140-6736(60)91103-x. [DOI] [PubMed] [Google Scholar]
  73. Samal K. C., Das S., Parija C. R., Tripathy B. B. C-peptide response to glycaemic stimuli. J Assoc Physicians India. 1987 May;35(5):362–364. [PubMed] [Google Scholar]
  74. Sandhyamani S. Vasculopathic and cardiomyopathic changes induced by low-protein high-carbohydrate tapioca based diet in bonnet monkey. Vasculopathic and cardiomyopathic changes in induced malnutrition. Am J Cardiovasc Pathol. 1992;4(1):41–50. [PubMed] [Google Scholar]
  75. Sastry N. G., Mohan V. Hemiplegia in a patient with fibrocalculous pancreatic diabetes. J Assoc Physicians India. 2000 Nov;48(11):1129–1129. [PubMed] [Google Scholar]
  76. Schneider Alexander, Suman Amitabh, Rossi Livio, Barmada M. Michael, Beglinger Christoph, Parvin Shahana, Sattar Soheli, Ali Liaquat, Khan A. K. Azad, Gyr Niklaus. SPINK1/PSTI mutations are associated with tropical pancreatitis and type II diabetes mellitus in Bangladesh. Gastroenterology. 2002 Oct;123(4):1026–1030. doi: 10.1053/gast.2002.36059. [DOI] [PubMed] [Google Scholar]
  77. Schultz A. C., Moore P. B., Geevarghese P. J., Pitchumoni C. S. X-ray diffraction studies of pancreatic calculi associated with nutritional pancreatitis. Dig Dis Sci. 1986 May;31(5):476–480. doi: 10.1007/BF01320310. [DOI] [PubMed] [Google Scholar]
  78. Slaff J., Jacobson D., Tillman C. R., Curington C., Toskes P. Protease-specific suppression of pancreatic exocrine secretion. Gastroenterology. 1984 Jul;87(1):44–52. [PubMed] [Google Scholar]
  79. Sood R., Ahuja M. M., Karmarkar M. G. Serum C-peptide levels in young ketosis-resistant diabetics. Indian J Med Res. 1983 Nov;78:661–664. [PubMed] [Google Scholar]
  80. THOMAS E., STEPHEN P. M. Pancreatic calculi. J Indian Med Assoc. 1954 Nov 16;24(4):126–128. [PubMed] [Google Scholar]
  81. Tandon Rakesh Kumar, Sato Nobuhiro, Garg Pramod Kumar, Consensus Study Group Chronic pancreatitis: Asia-Pacific consensus report. J Gastroenterol Hepatol. 2002 Apr;17(4):508–518. doi: 10.1046/j.1440-1746.2002.02762.x. [DOI] [PubMed] [Google Scholar]
  82. Teuscher T., Baillod P., Rosman J. B., Teuscher A. Absence of diabetes in a rural West African population with a high carbohydrate/cassava diet. Lancet. 1987 Apr 4;1(8536):765–768. doi: 10.1016/s0140-6736(87)92797-8. [DOI] [PubMed] [Google Scholar]
  83. Thomas P. G., Augustine P., Ramesh H., Rangabashyam N. Observations and surgical management of tropical pancreatitis in Kerala and southern India. World J Surg. 1990 Jan-Feb;14(1):32–42. doi: 10.1007/BF01670542. [DOI] [PubMed] [Google Scholar]
  84. Thomas P. G., Augustine P. Surgery in tropical pancreatitis. Br J Surg. 1988 Feb;75(2):161–164. doi: 10.1002/bjs.1800750225. [DOI] [PubMed] [Google Scholar]
  85. Uden S., Bilton D., Nathan L., Hunt L. P., Main C., Braganza J. M. Antioxidant therapy for recurrent pancreatitis: placebo-controlled trial. Aliment Pharmacol Ther. 1990 Aug;4(4):357–371. doi: 10.1111/j.1365-2036.1990.tb00482.x. [DOI] [PubMed] [Google Scholar]
  86. Vannasaeng S., Nitiyanant W., Vichayanrat A., Ploybutr S., Harnthong S. C-peptide secretion in calcific tropical pancreatic diabetes. Metabolism. 1986 Sep;35(9):814–817. doi: 10.1016/0026-0495(86)90221-0. [DOI] [PubMed] [Google Scholar]
  87. Whitcomb D. C. Genetic predispositions to acute and chronic pancreatitis. Med Clin North Am. 2000 May;84(3):531-47, vii. doi: 10.1016/s0025-7125(05)70238-8. [DOI] [PubMed] [Google Scholar]
  88. Whitcomb D. C., Gorry M. C., Preston R. A., Furey W., Sossenheimer M. J., Ulrich C. D., Martin S. P., Gates L. K., Jr, Amann S. T., Toskes P. P. Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet. 1996 Oct;14(2):141–145. doi: 10.1038/ng1096-141. [DOI] [PubMed] [Google Scholar]
  89. Whitcomb D. C. Hereditary pancreatitis: new insights into acute and chronic pancreatitis. Gut. 1999 Sep;45(3):317–322. doi: 10.1136/gut.45.3.317. [DOI] [PMC free article] [PubMed] [Google Scholar]
  90. Wiyono P. Exocrine and endocrine pancreatic function in malnutrition-related diabetes mellitus (MRDM) in Yogyakarta, Indonesia. Kobe J Med Sci. 1988 Oct;34(5):215–226. [PubMed] [Google Scholar]
  91. Yajnik C. S. Diabetes secondary to tropical calcific pancreatitis. Baillieres Clin Endocrinol Metab. 1992 Oct;6(4):777–796. doi: 10.1016/s0950-351x(05)80165-x. [DOI] [PubMed] [Google Scholar]
  92. Yajnik C. S., Katrak A., Kanitkar S. V., Naik S. S., D'Souza V., Dandona P. Serum immunoreactive trypsin in tropical pancreatic diabetes syndrome. Ann Clin Biochem. 1989 Jan;26(Pt 1):69–73. doi: 10.1177/000456328902600110. [DOI] [PubMed] [Google Scholar]
  93. Yajnik C. S., Sahasrabudhe R. A., Naik S. S., Katrak A., Shelgikar K. M., Kanitkar S. V., Narayanan V. A., Dandona P. Exocrine pancreatic function (serum immunoreactive trypsin, fecal chymotrypsin, and pancreatic isoamylase) in Indian diabetics. Pancreas. 1990 Nov;5(6):631–638. doi: 10.1097/00006676-199011000-00001. [DOI] [PubMed] [Google Scholar]
  94. Yajnik C. S., Shelgikar K. M., Naik S. S., Kanitkar S. V., Orskov H., Alberti K. G., Hockaday T. D. The ketosis-resistance in fibro-calculous-pancreatic-diabetes. 1. Clinical observations and endocrine-metabolic measurements during oral glucose tolerance test. Diabetes Res Clin Pract. 1992 Feb;15(2):149–156. doi: 10.1016/0168-8227(92)90019-n. [DOI] [PubMed] [Google Scholar]
  95. Yajnik C. S., Shelgikar K. M., Sahasrabudhe R. A., Naik S. S., Pai V. R., Alberti K. G., Hockaday T. D., Katrak A., Dandona P. The spectrum of pancreatic exocrine and endocrine (beta-cell) function in tropical calcific pancreatitis. Diabetologia. 1990 Jul;33(7):417–421. doi: 10.1007/BF00404091. [DOI] [PubMed] [Google Scholar]
  96. Yajnik C. S., Shelgikar K. M., Sahasrabudhe R. A., Naik S. S., Pai V. R., Alberti K. G., Hockaday T. D., Katrak A., Dandona P. The spectrum of pancreatic exocrine and endocrine (beta-cell) function in tropical calcific pancreatitis. Diabetologia. 1990 Jul;33(7):417–421. doi: 10.1007/BF00404091. [DOI] [PubMed] [Google Scholar]
  97. ZUIDEMA P. J. Cirrhosis and disseminated calcification of the pancreas in patients with malnutrition. Trop Geogr Med. 1959 Mar;11(1):70–74. [PubMed] [Google Scholar]

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