Regional variations in distribution, diagnosis and treatment of chronic pancreatitis in the mainland China: a systematic review of case articles over 40 years

BACKGROUND: Epidemiological data regarding the regional differences in chronic pancreatitis (CP) from the mainland of China is lacking. We aimed to gather and combine the information concerning the regional distribution and the risk factors associated with pancreatic cancer (PaCa) and death from published articles. METHODSː: Case articles on CP published in seven databases from January 1979 to December 2018 were analysed. RESULTS: A total of 4,452 cases articles (containing 161,243 CP cases) were included. Since the mid-1990s, the number of published articles grew rapidly, which was significantly related to the gross domestic product of the region. In recent years, the number of CP cases of idiopathic etiology, those receiving endoscopic treatment, those with comorbid diabetes mellitus and the number of Science Citation Index (SCI) case articles have increased. Surgical treatment (37.4%) was closely associated to alcoholic CP (r = 0.55, P = 0.000), idiopathic CP (r = 0.52, P = 0.000), wasting (r = 0.21, P = 0.000), jaundice (r = 0.27, P = 0.000), PaCa and death detected during hospitalization and follow-up, and was more common in underdeveloped areas. Endoscopic therapy (27.9%) was mainly concentrated in developed areas, associated with non-alcoholic CP and a higher incidence of death (r = 0.48, P = 0.000) and PaCa (r = 0.3, P = 0.000) during follow-up. The total number of PaCa in CP cases was significantly related to the number of PaCa cases in each region (r = 0.94, P = 0.002). PaCa detected during hospitalization was mainly related to jaundice, pain, diabetes, biliary diseases, alcoholic CP, conservative treatment and surgical treatment. CONCLUSIONS: The distribution of clinical features and management treasures showed obvious regional characteristics, which closely related to the local detection level of CP and PaCa, showing that there were likely to be many cases of misdiagnosis or delayed diagnosis of CP and PaCa. The problem of uneven distribution of medical resources, which related to the imbalance of economic and social development, needs to be resolved.