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
