Schneider et al report the M-ANNHEIM system for evaluating a patient with chronic pancreatitis. The various findings can be combined into a score indicative of disease severity. The system was developed at the the University of Heidelberg in Mannheim, Germany.
Patient selection: chronic pancreatitis
Parameters:
(1) pain
(2) pain control
(3) surgical intervention on the pancreas
(4) exocrine insufficiency
(5) endocrine insufficiency
(6) morphologic status on pancreatic imaging (using the Cambridge classification)
(7) severe organ complications
Parameter |
Finding |
Points |
pain |
no pain, no therapy |
0 |
|
episodes of acute pancreatitis with intermittent pain |
1 |
|
pain with control on therapy |
2 |
|
intermittent pain |
3 |
|
continuous pain |
4 |
pain control |
no medication |
0 |
|
use of nonopioid drugs or use of mild opioids |
1 |
|
use of potent opioids or endoscopic intervention |
2 |
surgical intervention |
none |
0 |
|
for any reason |
4 |
exocrine insufficiency |
absent |
0 |
|
mild, moderate or unproven with no need for enzyme supplement |
1 |
|
marked with steatorrhea and need for enzyme supplement |
2 |
endocrine insufficiency |
absence of diabetes |
0 |
|
presence of diabetes |
4 |
imaging status |
normal |
0 |
|
equivocal |
1 |
|
mild |
2 |
|
moderate |
3 |
|
marked |
4 |
severe organ complication |
absent |
0 |
|
presence of possibly reversible complications |
2 |
|
presence of irreversible complications |
4 |
where:
• Reversible complications: ascites, bleeding. pseudoaneurysm, obstruction or stricture of the ductus choledochus, pancreatic fistula, duodental stenosis.
• Irreversible complications: portal or splenic vein thrombosis, pancreatic cancer
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 24
• The higher the score the more severe the chronic pancreatitis.
Total Score |
Severity Level |
M-ANNHEIM Index |
0 to 5 |
minor |
A |
6 to 10 |
increased |
B |
11 to 15 |
advanced |
C |
16 to 20 |
marked |
D |
21 to 24 |
exacerbated |
E |
Specialty: Gastroenterology