Abstract
Chronic pancreatitis represents a condition that is challenging for clinicians secondary to the difficulty in making an accurate diagnosis and the less than satisfactory means of managing chronic pain. This review emphasises the various manifestations that patients with chronic pancreatitis may have and describes recent advances in medical and surgical therapy. It is probable that many patients with chronic abdominal pain are suffering from chronic pancreatitis that is not appreciated. As the pathophysiology of this disorder is better understood it is probable that the treatment will be more successful.
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Selected References
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- Amann S. T., Bishop M., Curington C., Toskes P. P. Fecal pancreatic elastase 1 is inaccurate in the diagnosis of chronic pancreatitis. Pancreas. 1996 Oct;13(3):226–230. doi: 10.1097/00006676-199610000-00002. [DOI] [PubMed] [Google Scholar]
- Ammann R. W., Akovbiantz A., Largiader F., Schueler G. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology. 1984 May;86(5 Pt 1):820–828. [PubMed] [Google Scholar]
- Andersen B. N., Pedersen N. T., Scheel J., Worning H. Incidence of alcoholic chronic pancreatitis in Copenhagen. Scand J Gastroenterol. 1982 Mar;17(2):247–252. doi: 10.3109/00365528209182047. [DOI] [PubMed] [Google Scholar]
- Buscher H. C. J. L., Jansen J. B. M. J., van Dongen R., Bleichrodt R. P., van Goor H. Long-term results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis. Br J Surg. 2002 Feb;89(2):158–162. doi: 10.1046/j.0007-1323.2001.01988.x. [DOI] [PubMed] [Google Scholar]
- Büchler M. W., Binder M., Friess H. Role of somatostatin and its analogues in the treatment of acute and chronic pancreatitis. Gut. 1994;35(3 Suppl):S15–S19. doi: 10.1136/gut.35.3_suppl.s15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Choudari Chintamaneni P., Nickl Nicholas J., Fogel Evan, Lehman Glen A., Sherman Stuart. Hereditary pancreatitis: clinical presentation, ERCP findings, and outcome of endoscopic therapy. Gastrointest Endosc. 2002 Jul;56(1):66–71. doi: 10.1067/mge.2002.125103. [DOI] [PubMed] [Google Scholar]
- Chowdhury Riaz S., Forsmark Chris E., Davis Richard H., Toskes Phillip P., Verne G. Nicholas. Prevalence of gastroparesis in patients with small duct chronic pancreatitis. Pancreas. 2003 Apr;26(3):235–238. doi: 10.1097/00006676-200304000-00005. [DOI] [PubMed] [Google Scholar]
- Civeira F., Cenarro A., Ferrando J., Puzo J., Garcia-Otín A. L., Mozas P., Pocoví M. Comparison of the hypolipidemic effect of gemfibrozil versus simvastatin in patients with type III hyperlipoproteinemia. Am Heart J. 1999 Jul;138(1 Pt 1):156–162. doi: 10.1016/s0002-8703(99)70262-0. [DOI] [PubMed] [Google Scholar]
- Clayton Heather A., Davies Joanna E., Pollard Cris A., White Steve A., Musto Patrick P., Dennison Ashley R. Pancreatectomy with islet autotransplantation for the treatment of severe chronic pancreatitis: the first 40 patients at the leicester general hospital. Transplantation. 2003 Jul 15;76(1):92–98. doi: 10.1097/01.TP.0000054618.03927.70. [DOI] [PubMed] [Google Scholar]
- Cohn J. A., Bornstein J. D., Jowell P. S. Cystic fibrosis mutations and genetic predisposition to idiopathic chronic pancreatitis. Med Clin North Am. 2000 May;84(3):621-31, ix. doi: 10.1016/s0025-7125(05)70245-5. [DOI] [PubMed] [Google Scholar]
- Cruz P. D., Jr, East C., Bergstresser P. R. Dermal, subcutaneous, and tendon xanthomas: diagnostic markers for specific lipoprotein disorders. J Am Acad Dermatol. 1988 Jul;19(1 Pt 1):95–111. doi: 10.1016/s0190-9622(88)70157-7. [DOI] [PubMed] [Google Scholar]
- De las Heras Castaño G., García de la Paz A., Fernández M. D., Fernández Forcelledo J. L. Use of antioxidants to treat pain in chronic pancreatitis. Rev Esp Enferm Dig. 2000 Jun;92(6):375–385. [PubMed] [Google Scholar]
- Di Sebastiano P., di Mola F. F., Di Febbo C., Baccante G., Porreca E., Innocenti P., Friess H., Büchler M. W. Expression of interleukin 8 (IL-8) and substance P in human chronic pancreatitis. Gut. 2000 Sep;47(3):423–428. doi: 10.1136/gut.47.3.423. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fernández-del Castillo C., Rattner D. W., Warshaw A. L. Standards for pancreatic resection in the 1990s. Arch Surg. 1995 Mar;130(3):295–300. doi: 10.1001/archsurg.1995.01430030065013. [DOI] [PubMed] [Google Scholar]
- Forsmark C. E., Toskes P. P. What does an abnormal pancreatogram mean? Gastrointest Endosc Clin N Am. 1995 Jan;5(1):105–123. [PubMed] [Google Scholar]
- Freeman M. L., DiSario J. A., Nelson D. B., Fennerty M. B., Lee J. G., Bjorkman D. J., Overby C. S., Aas J., Ryan M. E., Bochna G. S. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001 Oct;54(4):425–434. doi: 10.1067/mge.2001.117550. [DOI] [PubMed] [Google Scholar]
- Friess H., Yamanaka Y., Büchler M., Beger H. G., Do D. A., Kobrin M. S., Korc M. Increased expression of acidic and basic fibroblast growth factors in chronic pancreatitis. Am J Pathol. 1994 Jan;144(1):117–128. [PMC free article] [PubMed] [Google Scholar]
- Friess Helmut, Berberat Pascal O., Wirtz Martin, Büchler Markus W. Surgical treatment and long-term follow-up in chronic pancreatitis. Eur J Gastroenterol Hepatol. 2002 Sep;14(9):971–977. doi: 10.1097/00042737-200209000-00007. [DOI] [PubMed] [Google Scholar]
- Geenen J. E., Rolny P. Endoscopic therapy of acute and chronic pancreatitis. Gastrointest Endosc. 1991 May-Jun;37(3):377–382. doi: 10.1016/s0016-5107(91)70739-6. [DOI] [PubMed] [Google Scholar]
- Gress F., Schmitt C., Sherman S., Ciaccia D., Ikenberry S., Lehman G. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol. 2001 Feb;96(2):409–416. doi: 10.1111/j.1572-0241.2001.03551.x. [DOI] [PubMed] [Google Scholar]
- Gress F., Schmitt C., Sherman S., Ikenberry S., Lehman G. A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol. 1999 Apr;94(4):900–905. doi: 10.1111/j.1572-0241.1999.01042.x. [DOI] [PubMed] [Google Scholar]
- Gruessner Rainer W. G., Sutherland David E. R., Dunn David L., Najarian John S., Jie Tun, Hering Bernhard J., Gruessner Angelika C. Transplant options for patients undergoing total pancreatectomy for chronic pancreatitis. J Am Coll Surg. 2004 Apr;198(4):559–569. doi: 10.1016/j.jamcollsurg.2003.11.024. [DOI] [PubMed] [Google Scholar]
- Halgreen H., Pedersen N. T., Worning H. Symptomatic effect of pancreatic enzyme therapy in patients with chronic pancreatitis. Scand J Gastroenterol. 1986 Jan;21(1):104–108. doi: 10.3109/00365528609034631. [DOI] [PubMed] [Google Scholar]
- Hayakawa T., Kondo T., Shibata T., Noda A., Suzuki T., Nakano S. Relationship between pancreatic exocrine function and histological changes in chronic pancreatitis. Am J Gastroenterol. 1992 Sep;87(9):1170–1174. [PubMed] [Google Scholar]
- Hollerbach S., Klamann A., Topalidis T., Schmiegel W. H. Endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA) cytology for diagnosis of chronic pancreatitis. Endoscopy. 2001 Oct;33(10):824–831. doi: 10.1055/s-2001-17337. [DOI] [PubMed] [Google Scholar]
- Isaksson G., Ihse I. Pain reduction by an oral pancreatic enzyme preparation in chronic pancreatitis. Dig Dis Sci. 1983 Feb;28(2):97–102. doi: 10.1007/BF01315137. [DOI] [PubMed] [Google Scholar]
- Izbicki J. R., Bloechle C., Knoefel W. T., Rogiers X., Kuechler T. Surgical treatment of chronic pancreatitis and quality of life after operation. Surg Clin North Am. 1999 Aug;79(4):913–944. doi: 10.1016/s0039-6109(05)70051-7. [DOI] [PubMed] [Google Scholar]
- Jacobson D. G., Curington C., Connery K., Toskes P. P. Trypsin-like immunoreactivity as a test for pancreatic insufficiency. N Engl J Med. 1984 May 17;310(20):1307–1309. doi: 10.1056/NEJM198405173102007. [DOI] [PubMed] [Google Scholar]
- Kim Kyu-Pyo, Kim Myung-Hwan, Lee Sang Soo, Seo Dong Wan, Lee Sung Koo. Autoimmune pancreatitis: it may be a worldwide entity. Gastroenterology. 2004 Apr;126(4):1214–1214. doi: 10.1053/j.gastro.2004.02.044. [DOI] [PubMed] [Google Scholar]
- Layer P., Yamamoto H., Kalthoff L., Clain J. E., Bakken L. J., DiMagno E. P. The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology. 1994 Nov;107(5):1481–1487. doi: 10.1016/0016-5085(94)90553-3. [DOI] [PubMed] [Google Scholar]
- Layer P., Yamamoto H., Kalthoff L., Clain J. E., Bakken L. J., DiMagno E. P. The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology. 1994 Nov;107(5):1481–1487. doi: 10.1016/0016-5085(94)90553-3. [DOI] [PubMed] [Google Scholar]
- Mahley R. W., Huang Y., Rall S. C., Jr Pathogenesis of type III hyperlipoproteinemia (dysbetalipoproteinemia). Questions, quandaries, and paradoxes. J Lipid Res. 1999 Nov;40(11):1933–1949. [PubMed] [Google Scholar]
- Malesci A., Gaia E., Fioretta A., Bocchia P., Ciravegna G., Cantor P., Vantini I. No effect of long-term treatment with pancreatic extract on recurrent abdominal pain in patients with chronic pancreatitis. Scand J Gastroenterol. 1995 Apr;30(4):392–398. doi: 10.3109/00365529509093296. [DOI] [PubMed] [Google Scholar]
- Malfertheiner P., Mayer D., Büchler M., Domínguez-Muñoz J. E., Schiefer B., Ditschuneit H. Treatment of pain in chronic pancreatitis by inhibition of pancreatic secretion with octreotide. Gut. 1995 Mar;36(3):450–454. doi: 10.1136/gut.36.3.450. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Massucco P., Calgaro M., Bertolino F., Bima C., Galatola G., Capussotti L. Outcome of surgical treatment for chronic calcifying pancreatitis. Pancreas. 2001 May;22(4):378–382. doi: 10.1097/00006676-200105000-00007. [DOI] [PubMed] [Google Scholar]
- McCleane G. J. The cholecystokinin antagonist proglumide has an analgesic effect in chronic pancreatitis. Pancreas. 2000 Oct;21(3):324–325. doi: 10.1097/00006676-200010000-00016. [DOI] [PubMed] [Google Scholar]
- McLeod R. S., Taylor B. R., O'Connor B. I., Greenberg G. R., Jeejeebhoy K. N., Royall D., Langer B. Quality of life, nutritional status, and gastrointestinal hormone profile following the Whipple procedure. Am J Surg. 1995 Jan;169(1):179–185. doi: 10.1016/s0002-9610(99)80129-9. [DOI] [PubMed] [Google Scholar]
- Mössner J. Palliation of pain in chronic pancreatitis. Use of enzymes. Surg Clin North Am. 1999 Aug;79(4):861-72, xi. doi: 10.1016/s0039-6109(05)70048-7. [DOI] [PubMed] [Google Scholar]
- Mössner J., Secknus R., Meyer J., Niederau C., Adler G. Treatment of pain with pancreatic extracts in chronic pancreatitis: results of a prospective placebo-controlled multicenter trial. Digestion. 1992;53(1-2):54–66. doi: 10.1159/000200971. [DOI] [PubMed] [Google Scholar]
- Okazaki Kazuichi. Autoimmune pancreatitis is increasing in Japan. Gastroenterology. 2003 Nov;125(5):1557–1558. doi: 10.1016/j.gastro.2003.09.011. [DOI] [PubMed] [Google Scholar]
- Okolo P. I., 3rd, Pasricha P. J., Kalloo A. N. What are the long-term results of endoscopic pancreatic sphincterotomy? Gastrointest Endosc. 2000 Jul;52(1):15–19. doi: 10.1067/mge.2000.106669. [DOI] [PubMed] [Google Scholar]
- Rodriguez Rilo Horacio L., Ahmad Syed A., D'Alessio David, Iwanaga Yasuhiro, Kim Joseph, Choe Kyuran A., Moulton Jonathan S., Martin Jill, Pennington Linda J., Soldano Debbie A. Total pancreatectomy and autologous islet cell transplantation as a means to treat severe chronic pancreatitis. J Gastrointest Surg. 2003 Dec;7(8):978–989. doi: 10.1016/j.gassur.2003.09.008. [DOI] [PubMed] [Google Scholar]
- Rösch T., Daniel S., Scholz M., Huibregtse K., Smits M., Schneider T., Ell C., Haber G., Riemann J-F, Jakobs R. Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up. Endoscopy. 2002 Oct;34(10):765–771. doi: 10.1055/s-2002-34256. [DOI] [PubMed] [Google Scholar]
- Sakorafas G. H., Farnell M. B., Farley D. R., Rowland C. M., Sarr M. G. Long-term results after surgery for chronic pancreatitis. Int J Pancreatol. 2000 Apr;27(2):131–142. doi: 10.1385/IJGC:27:2:131. [DOI] [PubMed] [Google Scholar]
- Shiratori Keiko, Takeuchi Tadashi, Satake Katsusuke, Matsuno Seiki, Study Group of Loxiglumide in Japan Clinical evaluation of oral administration of a cholecystokinin-A receptor antagonist (loxiglumide) to patients with acute, painful attacks of chronic pancreatitis: a multicenter dose-response study in Japan. Pancreas. 2002 Jul;25(1):e1–e5. doi: 10.1097/00006676-200207000-00003. [DOI] [PubMed] [Google Scholar]
- Slaff J. I., Wolfe M. M., Toskes P. P. Elevated fasting cholecystokinin levels in pancreatic exocrine impairment: evidence to support feedback regulation. J Lab Clin Med. 1985 Mar;105(3):282–285. [PubMed] [Google Scholar]
- Slaff J., Jacobson D., Tillman C. R., Curington C., Toskes P. Protease-specific suppression of pancreatic exocrine secretion. Gastroenterology. 1984 Jul;87(1):44–52. [PubMed] [Google Scholar]
- Somogyi Lehel, Ross Shea O., Cintron Miriam, Toskes Phillip P. Comparison of biologic porcine secretin, synthetic porcine secretin, and synthetic human secretin in pancreatic function testing. Pancreas. 2003 Oct;27(3):230–234. doi: 10.1097/00006676-200310000-00006. [DOI] [PubMed] [Google Scholar]
- Steer M. L., Waxman I., Freedman S. Chronic pancreatitis. N Engl J Med. 1995 Jun 1;332(22):1482–1490. doi: 10.1056/NEJM199506013322206. [DOI] [PubMed] [Google Scholar]
- Toskes P. P., Hansell J., Cerda J., Deren J. J. Vitamin B 12 malabsorption in chronic pancreatic insufficiency. N Engl J Med. 1971 Mar 25;284(12):627–632. doi: 10.1056/NEJM197103252841202. [DOI] [PubMed] [Google Scholar]
- Toskes P. P. Update on diagnosis and management of chronic pancreatitis. Curr Gastroenterol Rep. 1999 Apr;1(2):145–153. doi: 10.1007/s11894-996-0014-8. [DOI] [PubMed] [Google Scholar]
- Uden S., Bilton D., Nathan L., Hunt L. P., Main C., Braganza J. M. Antioxidant therapy for recurrent pancreatitis: placebo-controlled trial. Aliment Pharmacol Ther. 1990 Aug;4(4):357–371. doi: 10.1111/j.1365-2036.1990.tb00482.x. [DOI] [PubMed] [Google Scholar]
- Uhl W., Anghelacopoulos S. E., Friess H., Büchler M. W. The role of octreotide and somatostatin in acute and chronic pancreatitis. Digestion. 1999;60 (Suppl 2):23–31. doi: 10.1159/000051477. [DOI] [PubMed] [Google Scholar]
- Wahoff D. C., Papalois B. E., Najarian J. S., Kendall D. M., Farney A. C., Leone J. P., Jessurun J., Dunn D. L., Robertson R. P., Sutherland D. E. Autologous islet transplantation to prevent diabetes after pancreatic resection. Ann Surg. 1995 Oct;222(4):562–579. doi: 10.1097/00000658-199522240-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Walsh T. N., Rode J., Theis B. A., Russell R. C. Minimal change chronic pancreatitis. Gut. 1992 Nov;33(11):1566–1571. doi: 10.1136/gut.33.11.1566. [DOI] [PMC free article] [PubMed] [Google Scholar]