TIGER-O classification for chronic pancreatitits
| Category | Etiologic Risk Factors |
|---|---|
| Toxic-Metabolic | Alcohol, Tobacco Smoking, Hypercalcemia, Hyperparathyroidism, Hyperlipidemia (Rare), Chronic Renal Failure, Medications (e.g., Phenacetin Abuse), and Toxins (e.g., Organotin Compounds) |
| Idiopathic | Early Onset Idiopathic, Late Onset Idiopathic, Tropical Calcific Pancreatitis, and Fibrocalculous Pancreatic Diabetes |
| Genetic | Autosomal Dominant - Cationic Trypsinogen Mutations at Codon 29 and 122; Autosomal Recessive/Modifier Genes - CFTR Mutations, SPINK1 Mutations, Cationic Trypsinogen Mutations at Codon 16, 22, 23, and Antitrypsin Deficiency - Possible |
| Autoimmune | Isolated, Syndromic, Sjogren Syndrome, Inflammatory Bowel Disease, Primary Biliary Cirrhosis |
| Recurrent and Severe Acute Pancreatitis | Post-necrotic (severe acute Pancreatitis), Recurrent Acute Pancreatitis, Vascular Diseases/Ischemic, Post-irradiation, |
| Obstructive | Pancreatic Divisum, Sphincter of Oddi Disorders - Controversial, Duct Obstruction - e.g., Tumor, Preampullary Duodenal Wall Cysts, and Posttraumatic Pancreatic Duct Scars |
TIGAR-O 2L (Long Form):
| Category | Etiologic Risk Factors | |
|---|---|---|
| Toxic-Metabolic | Alcohol-Related (Susceptibility and/or Progression): | [1] 0 to <1 drink per day (Includes abstainers and occasional drinkers) |
| [2] 1–2 drinks/d | ||
| [3] 3–4 drinks/d | ||
| [4] 5 or more drinks/d | ||
| [1; 2; 3; 4] Susceptibility (pre-acute pancreatitis) [1; 2; 3; 4] Progression (post-acute pancreatitis) |
||
| Smoking (If yes, record pack-years): | 1. Non-smoker (<100 cigarettes in lifetime) 2. Past smoker 3. Current smoker 4. Other, NOS |
|
| Hypercalcemia | Total calcium levels >12.0 mg/dL or 3 mmol/L | |
| Hypertriglyceridemia: | 1. Hypertriglyceridemic risk (Fasting >300 mg/dL; non-fasting >500 mg/dL) 2. Hypertriglyceridemic acute pancreatitis, history of (>500 mg/dL in first 72 hours) 3. Familial hypertriglyceridemia (by family history) |
|
| Medications | NOS | |
| Chronic kidney disease (CKD)—(CKD Stage 5: end-stage renal disease, ESRD) | 1. No dialysis 2. On dialysis 3. Kidney Transplant |
|
| Oxidative stress-associated factors | 1. Radiation/chemotherapy 2. Vascular insufficiency 3. Other factors |
|
| Diabetes Mellitus (with the date of diagnosis if available) | 1. Diet controlled 2. Medication controlled (oral agents) 3. Insulin required (≥ 10 U/d or ≥ 0.1 U/kg/d) |
|
| Diet controlled | Red meat ≥ 2 oz or 57 g per day /Vegetarian/ Vegan | |
| Obsesity | BMI > 30 kg/m2 | |
| Visceral adiposity | ||
| Other NOS | ||
| Idiopathic | Early onset (<35 years of age) | |
| Late onset (>35 years of age) | ||
| Other NOS | ||
| Genetic | Suspected; No or limited genotyping available | |
| Autosomal dominant (Mendelian inheritance—single gene syndrome): | 1. PRSS1 mutations (Hereditary pancreatitis) 2. CEL—MODY8 phenotype 3. Other, NOS |
|
| Autosomal recessive (Mendelian inheritance—single gene syndrome): | 1. CFTR, 2 severe variants in trans (cystic fibrosis) 2. CFTR, <2 severe variants in trans (CFTR-RD) 3. SPINK1, 2 pathogenic variants in trans. (SPINK1-associated familial pancreatitis) 14. Others, NOS |
|
| Complex genetics—(non-Mendelian, complex genotypes +/- environment): | 1. CFTR variant (1 variant or >1 all in cis) 2. CTRC variants 3. CASR variants 4. SPINK1 variant (1 variant or >1 all in cis) 5. CPA1 variants 6. CEL or CEL-HYB variants 7. Other, NOS |
|
| Modifier Genes (list pathogenic genetic variants): | 1. PRSS1-PRSS1 locus 2. CLDN2 locus 3. SLC26A9 4. GGT1 5. ABO-B blood type 6. Others, NOS |
|
| Hypertriglyceridemia (list pathogenic genetic variants): | 1. LPL—lipoprotein lipase deficiency 2. APOC2—Apolipoprotein C-II deficiency 3. Other familial chylomicronemia syndrome (FCS) 4. Multifactorial chylomicronemia syndrome (MCS) 5. Other, NOS |
|
| Rare, non-neoplastic pancreatic genetic variant-associated syndromes: | 1. Shwachman-Diamond syndrome 2. Johanson-Blizzard Syndrome 3. Mitochondrial disorders (e.g., Pearson's Marrow-Pancreas Syndrome) 4. Other, NOS |
|
| Autoimmune Pancreatitis | AIP Type 1—IgG4-related disease: | 1. Isolated to the pancreas 2. Associated with other organs (IgG4-related disease) |
| AIP Type 2: | 1. Isolated to the pancreas 2. With Crohn's disease 3. With ulcerative colitis 4. Associated with other organs |
|
| AIP-NOS (Steroid responsive, not Type1 or Type 2) | ||
| Recurrent and Severe Acute Pancreatitis | 1. Acute pancreatitis (single episode, including date of event if available) | 1. AP without persistent MOF and <30% PNec 2. AP without persistent MOF and >30% PNec 3. SAP (persistent MAF with <30% PNec) 4. SAP (persistent MAF with ≥30% PNec) |
| 2. AP Etiology—Extra-pancreatic (excluding alcoholic, HTG, hypercalcemia, genetic) | 1. Biliary pancreatitis 2. Post-ERCP 3. Traumatic 4. Ischemic (acute, such as postsurgical, hypotension) 5. Infectious: Viral, other (not secondary infection) 6. Undetermined or NOS |
|
| 3. Recurrent acute pancreatitis (number of episodes, frequency, and dates of events if available) | ||
| Obstructive Etiology | 1. Pancreas Divisum 2. Ampullary Stenosis 3. Main Duct Pancreatic Stones 4. Widespread Pancreatic Calcifications 5. Main Pancreatic Duct Strictures 6. Mass Effect, NOS 7. Other Anatomic Variants 8. Other, NOS | |
| 9. Localized Mass Causing Duct Obstruction | 1. Pancreatic ductal adenocarcinoma 2. IPMN 3. Other tumors |
- Whitcomb, David C, and North American Pancreatitis Study Group. “Pancreatitis: TIGAR-O Version 2 Risk/Etiology Checklist With Topic Reviews, Updates, and Use Primers.” Clinical and translational gastroenterology vol. 10,6 (2019): e00027. doi:10.14309/ctg.0000000000000027