Title: Analysis of risk factors related to acute exacerbation in patients with chronic pancreatitis:
a retrospective study of 313 cases from a single center in China
Version: 3 Date: 10 Sep 2024
Reviewer's report:
This study is extremely valuable in identifying independent risk and protective factors for
ACP in patients with CP. There are no universally accepted criteria for the diagnosis of
chronic pancreatitis and ACP. Although this is an important study that clarified the clinical
characteristics of ACP in patients with chronic pancreatitis, there are several issues that need
to be addressed.
1# The authors used the Asia Pacific consensus to diagnose chronic pancreatitis, but other
diagnostic criteria are commonly used worldwide.
1) Hoffmeister A, Mayerle J, Beglinger C, et al. English language version of the S3-consensus
guidelines on chronic pancreatitis: definition, aetiology, diagnostic examinations, medical,
endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol 2015; 53: 1447–
95.
2) Whitcomb DC, Shimosegawa T, Chari ST, et al. International consensus statements on
early chronic pancreatitis. Recommendations from the working group for the international
consensus guidelines for chronic pancreatitis in collaboration with The International Association
of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest
Working Group and European Pancreatic Club. Pancreatology 2018; 18: 516–27.
3) Shimizu K, Ito T, Irisawa A, et al. Evidence-based clinical practice guidelines
for chronic pancreatitis 2021. J Gastroenterol 2022; Oct;57(10):709-724. doi: 10.1007/
s00535-022-01911-6..
4) Löhr JM, Dominguez-Munoz E, Rosendahl J, et al. United European Gastroenterology
evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU).
United European Gastroenterol J 2017; 5: 153–99.
Georg Beyer, Aida Habtezion, Jens Werner, Markus M Lerch, Julia Mayerle Chronic
pancreatitis Lancet 2020; 396: 499–512
2# Continued alcohol consumption is thought to contribute to the development of ACP or RAP.
Please consider whether to continue or stop drinking alcohol.
3# Please state whether or not there was pancreatic stones, and in patients who have them, the
location of the stones.
4# Patients with chronic pancreatitis not only suffer from endocrine dysfunction, but also from
exocrine dysfunction. Clinical findings such as weight loss and diarrhea were clearly stated, but
did you evaluate exocrine function? For example, PT-PABA test, fecal elastase 1, and so on.
Please describe if there is any.
5# In addition to reducing pain and prohibiting alcohol consumption, patients with chronic
pancreatitis might be treated with pancreatic enzyme replacement therapy. Please discuss the
preventive effects of ACP in patients who have received pancreatic enzyme replacement therapy.
6# In the results section, Table 4 states that pancreatic atrophy was a protective factor, but it
was not shown. Please check it carefully.
Title: Analysis of risk factors related to acute exacerbation in patients with chronic pancreatitis:
a retrospective study of 313 cases from a single center in China
Version: 3 Date: 10 Sep 2024
Reviewer's report:
This study is extremely valuable in identifying independent risk and protective factors for
ACP in patients with CP. There are no universally accepted criteria for the diagnosis of
chronic pancreatitis and ACP. Although this is an important study that clarified the clinical
characteristics of ACP in patients with chronic pancreatitis, there are several issues that need
to be addressed.
1# The authors used the Asia Pacific consensus to diagnose chronic pancreatitis, but other
diagnostic criteria are commonly used worldwide.
1) Hoffmeister A, Mayerle J, Beglinger C, et al. English language version of the S3-consensus
guidelines on chronic pancreatitis: definition, aetiology, diagnostic examinations, medical,
endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol 2015; 53: 1447–
95.
2) Whitcomb DC, Shimosegawa T, Chari ST, et al. International consensus statements on
early chronic pancreatitis. Recommendations from the working group for the international
consensus guidelines for chronic pancreatitis in collaboration with The International Association
of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest
Working Group and European Pancreatic Club. Pancreatology 2018; 18: 516–27.
3) Shimizu K, Ito T, Irisawa A, et al. Evidence-based clinical practice guidelines
for chronic pancreatitis 2021. J Gastroenterol 2022; Oct;57(10):709-724. doi: 10.1007/
s00535-022-01911-6..
4) Löhr JM, Dominguez-Munoz E, Rosendahl J, et al. United European Gastroenterology
evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU).
United European Gastroenterol J 2017; 5: 153–99.
Georg Beyer, Aida Habtezion, Jens Werner, Markus M Lerch, Julia Mayerle Chronic
pancreatitis Lancet 2020; 396: 499–512
2# Continued alcohol consumption is thought to contribute to the development of ACP or RAP.
Please consider whether to continue or stop drinking alcohol.
3# Please state whether or not there was pancreatic stones, and in patients who have them, the
location of the stones.
4# Patients with chronic pancreatitis not only suffer from endocrine dysfunction, but also from
exocrine dysfunction. Clinical findings such as weight loss and diarrhea were clearly stated, but
did you evaluate exocrine function? For example, PT-PABA test, fecal elastase 1, and so on.
Please describe if there is any.
5# In addition to reducing pain and prohibiting alcohol consumption, patients with chronic
pancreatitis might be treated with pancreatic enzyme replacement therapy. Please discuss the
preventive effects of ACP in patients who have received pancreatic enzyme replacement therapy.
6# In the results section, Table 4 states that pancreatic atrophy was a protective factor, but it
was not shown. Please check it carefully.
Please review this paper.
user
Title: Analysis of risk factors related to acute exacerbation in patients with chronic pancreatitis:
a retrospective study of 313 cases from a single center in China
Version: 3 Date: 10 Sep 2024
Reviewer's report:
This study is extremely valuable in identifying independent risk and protective factors for
ACP in patients with CP. There are no universally accepted criteria for the diagnosis of
chronic pancreatitis and ACP. Although this is an important study that clarified the clinical
characteristics of ACP in patients with chronic pancreatitis, there are several issues that need
to be addressed.
1# The authors used the Asia Pacific consensus to diagnose chronic pancreatitis, but other
diagnostic criteria are commonly used worldwide.
1) Hoffmeister A, Mayerle J, Beglinger C, et al. English language version of the S3-consensus
guidelines on chronic pancreatitis: definition, aetiology, diagnostic examinations, medical,
endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol 2015; 53: 1447–
95.
2) Whitcomb DC, Shimosegawa T, Chari ST, et al. International consensus statements on
early chronic pancreatitis. Recommendations from the working group for the international
consensus guidelines for chronic pancreatitis in collaboration with The International Association
of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest
Working Group and European Pancreatic Club. Pancreatology 2018; 18: 516–27.
3) Shimizu K, Ito T, Irisawa A, et al. Evidence-based clinical practice guidelines
for chronic pancreatitis 2021. J Gastroenterol 2022; Oct;57(10):709-724. doi: 10.1007/
s00535-022-01911-6..
4) Löhr JM, Dominguez-Munoz E, Rosendahl J, et al. United European Gastroenterology
evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU).
United European Gastroenterol J 2017; 5: 153–99.
Georg Beyer, Aida Habtezion, Jens Werner, Markus M Lerch, Julia Mayerle Chronic
pancreatitis Lancet 2020; 396: 499–512
2# Continued alcohol consumption is thought to contribute to the development of ACP or RAP.
Please consider whether to continue or stop drinking alcohol.
3# Please state whether or not there was pancreatic stones, and in patients who have them, the
location of the stones.
4# Patients with chronic pancreatitis not only suffer from endocrine dysfunction, but also from
exocrine dysfunction. Clinical findings such as weight loss and diarrhea were clearly stated, but
did you evaluate exocrine function? For example, PT-PABA test, fecal elastase 1, and so on.
Please describe if there is any.
5# In addition to reducing pain and prohibiting alcohol consumption, patients with chronic
pancreatitis might be treated with pancreatic enzyme replacement therapy. Please discuss the
preventive effects of ACP in patients who have received pancreatic enzyme replacement therapy.
6# In the results section, Table 4 states that pancreatic atrophy was a protective factor, but it
was not shown. Please check it carefully.
assistant