Schneider et al report the M-ANNHEIM system for evaluating a patient with chronic pancreatitis. This includes criteria for making the diagnosis. The system was developed at the the University of Heidelberg in Mannheim, Germany.
Patient selection: chronic pancreatitis
Parameters:
(1) pancreatic calcifications
(2) ductal lesions according to the Cambridge criteria
(3) exocrine function
(4) endocrine function
(5) histologic changes in an adequate specimen
(6) recurrent or persistent pseudocysts
(7) family history of pancreatic disease
(8) presence of M-ANNHEIM risk factors, including amount of alcohol consumption
Criteria for definite chronic pancreatitis - one or more of the following:
(1) pancreatic calcifications
(2) moderate or marked ductal lesions by the Cambridge classification
(3) marked and persistent exocrine insufficiency (steatorrhea marked reduced by enzyme therapy)
(4) typical histology
Criteria for probable chronic pancreatitis - not definite and one or more of the following:
(1) mild ductal alterations by the Cambridge classification
(2) recurrent or persistent pseudocyts
(3) abnormal laboratory test for pancreatic exocrine function
(4) endocrine insufficiency (abnormal glucose tolerance test)
Criteria for borderline chronic pancreatitis - all of the following:
(1) does not meet criteria for definite or probable chronic pancreatitis
(2) one of the following:
(2a) typical clinical history
(2b) episode of acute pancreatitis with family history of pancreatic disease
(2c) episode of acute pancreatitis with other M-ANNHEIM risk factors
Pancreatitis associated with alcohol consumption was designated:
(1) definitive, probable or borderline based on the above criteria
(2) designated by the level of alcohol consumption
(2a) excessive if > 80 g per day for some years in men
(2b) increased if 20 to 80 g per day for some years in men
(2c) moderate if < 20 g per day for some years in men
