Review of idiopathic pancreatitis

inflammation within the pancreas.Acute pancreatitis (AP) results in acute inflammation typically presenting as abdominal pain with elevated levels of pancreatic enzymes [1] .Chronic pancreatitis (CP) is defined as a clinical syndrome of progressive inflammatory changes in the pancreas leading to permanent structural damage with subsequent impairment of both exocrine and endocrine function [2] .Chronic pancreatitis is often preceded by recurrent bouts of acute pancreatitis, however, occasionally it can present in a 'silent' fashion.The label of "idiopathic pancreatitis" (IP) was originally designated to cases of pancreatitis wherein a diagnosis could not be made through a thorough history, physical examination, laboratory studies, and noninvasive imaging modalities such as abdominal ultrasonography/ computerized tomography.Previously, this nomenclature had accounted for 8%-44% of cases being ter med "idiopathic" [3][4][5][6][7][8][9] .Recent new laboratory and technological advances have been able to shred the enigmatic veils of IP to a point wherein with extensive evaluation it is possible to reveal the etiology in 79%-80% of patients previously labeled as having "idiopathic pancreatitis" [10,11] .More modern imaging investigations include, but are not limited to fine cut computerized tomography, endoscopic retrog rade pancreatog raphy, magnetic resonance pancreatography as well as endoscopic ultrasound. EPIDEMIOLOGYLongitudinal data on incidence trends report an increase in AP [12] which may be attributable to increases in all causes of pancreatitis as well as improved detection methods.The fatality rate for pancreatitis has continued to range between 3%-10% [13][14][15][16][17][18] despite a marked decrease in pancreatitis case fatality presumably secondary to early recognition of severity and complications as well as improved intensive care management [14,15] .Thomson [6] and others [7,17] have noted that in AP mortality rates are greater when the etiology is IP (14.1%) [6] , compared with gallstone pancreatitis (7.2%) [6] .In addition, the clinical impact of IP is further highlighted by the fact that 40 percent (the largest subgroup) of all AP fatalities are attributable to IP [19,20] .The incidence of IP ranges from 4.21 per 100 000 [21] to as high as 45.33 per 100 000 [9] depending on the population studied and the time in which data was collected with a trend toward high incidence in populations studied more recently [12,13,22] .The incidence appears to be

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