["Senile" chronic pancreatitis; a new nosologic entity? Studies in 38 cases. Indications of a vascular origin and relationship to the primarily painless chronic pancreatitis].

47 of 170 cases of chronic pancreatitis observed and controlled in the last 12 years in this department were of unknown etiology (idiopathic form). The age distribution of these 47 cases showed 2 peaks, a "juvenile" group of 9 cases (average age 29 years) and a "senile" group of 38 cases (average age 62 years). Idiopathic "senile" chronic pancreatitis (ISCP) is characterized by advanced age at the time of first manifestation (95% over 50 years), a prevalence of males (81%), a high incidence of calcifications (60%) and a rather benign, often painles course (74%). Clinically there is some overlap between ISCP and painless chronic pancreatitis (PSCP). In contrast to PSCP, ISCP seems, however, to comprise a homogeneous group of patients as far as etiology is concerned, and typical episodes of pancreatitis occurred in about 25% of cases with ISCP. Ther is an unusually high incidence of signs of arteriopathy associated with ISCP. Arteritis of the lower limbs and/or coronary heart disease was detected in 42% of cases, 14 of 17 deaths were due to cardiovascular disease and arteriosclerotic risk factors were found in 87% of the patients. In our experience ISCP seems to be a special form of chronic pancreatitis which can be differentiated from alcohol-induced chronic pancreatitis and from the other forms with rare causes. Furthermore, our findings suggest that a vascular factor is of importance in causing ISCP.