Comprehensive review of diagnostic modalities for early chronic pancreatitis

Table 1 Revised TIGAR-O aetiology criteria

Toxic-metabolic
Alcohol-related
0 to < 1 drinks/d
1-2 drinks/d
3-4 drinks/d
5 or more drinks/d
Smoking
Non-smoker (< 100 cigarettes in lifetime)
Past smoker
Current smoker (patients undergoing both past and ongoing cigarette exposure)
Other, not otherwise specified
Hypercalcaemia (total calcium levels > 12.0 mg/dL or 3 mmol/L)
Hypertriglyceridemia
Hypertriglyceridemia risk (fasting glucose > 300 mg/dL; non-fasting glucose > 500 mg/dL)
Hypertriglyceridemia in acute pancreatitis (history of glucose > 500 mg/dL in first 72 h of AP onset)
Medications
Toxins, other
Chronic kidney disease [CKD Stage 5: end-stage renal disease (ESRD)]
Other, not otherwise specified
Idiopathic
Early-onset (< 35 yr of age)
Late-onset (> 35 yr of age)
Genetic
Suspected; no or limited genotyping available
Autosomal dominant (Mendelian inheritance-single gene syndrome)
PRSS1 mutations (hereditary pancreatitis)
Autosomal recessive (Mendelian inheritance-single gene syndrome)
CFTR, 2 severe variants in trans (cystic fibrosis)
CFTR, < 2 severe variants in trans (CFTR-RD)
SPINK1, 2 pathogenic variants in trans (SPINK1-associated familial pancreatitis)
Complex genetics (non-Mendelian, complex genotypes +/- environment)
Modifier Genes (pathogenic genetic variants)
PRSS1-PRSS1 locus
CLDN2 locus
Others
Hypertriglyceridemia
Other, not otherwise specified
Autoimmune pancreatitis (AIP)/ steroid responsive pancreatitis
AIP Type 1—IgG4-related disease
AIP Type 2
Recurrent acute pancreatitis (RAP) and severe acute pancreatitis (SAP)
Acute pancreatitis (single episode, including date of event if available)
AP aetiology—Extra-pancreatic (excluding alcoholic, HTG, hypercalcaemia, genetic)
Biliary pancreatitis
Post-ERCP
Traumatic
Undetermined or not otherwise specified
Recurrent acute pancreatitis (number of episodes, frequency, and dates of events if available)
Obstructive
Pancreas divisum
Ampullary stenosis
Main duct pancreatic stones
Widespread pancreatic calcifications
Main pancreatic duct strictures
Localized mass causing duct obstruction

From the short form of TIGAR-O version 2 risk/aetiology checklist (2019)[13]. AP: Acute pancreatitis; CKD: Chronic kidney disease; HTG: Hyper-triglyceridemia; ERCP: Endoscopic retrograde cholangiopancreatography.