Table 4 M-ANNHEIM clinical staging of chronic pancreatitis

Asymptomatic chronic pancreatitis

 0 Stage of subclinical chronic pancreatitis

  a Period without symptoms (determination by chance, e.g., autopsy)

  b Acute pancreatitis—single episode (possible onset of chronic pancreatitis)

  c Acute pancreatitis with severe complications^a

Symptomatic chronic pancreatitis

 I Stage without pancreatic insufficiency

  a (Recurrent) acute pancreatitis (no pain between episodes of acute pancreatitis)

  b Recurrent or chronic abdominal pain (including pain between episodes of acute pancreatitis)

  c I a/b with severe complications^a

 II Stage of partial pancreatic insufficiency

  a Isolated exocrine (or endocrine) pancreatic insufficiency (without pain)

  b Isolated exocrine (or endocrine) pancreatic insufficiency (with pain)

  c II a/b with severe complications^a

 III Stage of painful complete pancreatic insufficiency

  a Exocrine and endocrine insufficiency (with pain, e.g., requiring analgesic medication)

  b III a with severe complications^a

 IV Stage of secondary painless disease (burnout)

  a Exocrine and endocrine insufficiency without pain and without severe complications^a

  b Exocrine and endocrine insufficiency without pain and with severe complications^a