Clinical presentation of painless pancreatitis: a systematic review

Painless pancreatitis is a slowly developing syndrome that involves inflammation, scarring and thickening of pancreatic cells and is often difficult to clinically diagnose due to lack of pain and indolent course. Thus, to increase awareness of this disease and improve its diagnosis, we conducted this study to investigate the epidemiology, clinical presentation and outcomes of painless pancreatitis. This systematic review was designed to investigate the epidemiology, clinical course and presentation, cause and comorbidities of painless pancreatitis. The PubMed database was used to search for the following keywords: "Clinical presentation", "painless pancreatitis" and "case report" until August 2021. The following data were collected: country, age, gender, alkaline phosphatase, total bilirubin, lipase, amylase, comorbidity of hypertension, diabetes mellitus, alcohol consumption, symptoms of malaise, jaundice, diarrhea, vomiting, surgical intervention, drain and analyzed statistically. There are 23 cases from 22 case reports enrolled into study. The mean age of the included patients was 44.7 +/- 20.6 years old. Males accounted for 73.9% of all cases. The rate of a personal history of smoking and alcohol drinking was 46.2% and 31.6%. A history of hypertension and diabetes was observed in 8.7% and 17.4% of the cases. Fever was documented in 75% of cases. A significant and positive correlation was observed between biochemistry results, including amylase and lipase, total bilirubin and direct bilirubin, and painless pancreatitis (r = 0.571 and r = 0.193). Alkaline phosphatase and the victim's age were negatively correlated with painless pancreatitis (r = -0.183, p = 0.042). In this study, we found that painless pancreatitis was predominant in males and presented mainly with fever, distended abdomen without pain. A personal history of smoking and alcohol drinking was observed in 46.2% and 31.6% of cases.