Journal ArticleDOI
Diagnosis and Management of Chronic Pancreatitis: A Review.
TLDR
Treatment consists primarily of alcohol and smoking cessation, pain control, replacement of pancreatic insufficiency, or mechanical drainage of obstructed pancreatic ducts for some patients, which may provide better pain relief among people who do not respond to endoscopic therapy.Abstract:
Importance Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas with a prevalence of 42 to 73 per 100 000 adults in the United States. Observations Both genetic and environmental factors are thought to contribute to the pathogenesis of CP. Environmental factors associated with CP include alcohol abuse (odds ratio [OR], 3.1; 95% CI, 1.87-5.14) for 5 or more drinks per day vs abstainers and light drinkers as well as smoking (OR, 4.59; 95% CI, 2.91-7.25) for more than 35 pack-years in a case-control study involving 971 participants. Between 28% to 80% of patients are classified as having “idiopathic CP.” Up to 50% of these individuals have mutations of the trypsin inhibitor gene (SPINK1) or the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Approximately 1% of people diagnosed with CP may have hereditary pancreatitis, associated with cationic trypsinogen (PRSS1) gene mutations. Approximately 80% of people with CP present with recurrent or chronic upper abdominal pain. Long-term sequelae include diabetes in 38% to 40% and exocrine insufficiency in 30% to 48%. The diagnosis is based on pancreatic calcifications, ductal dilatation, and atrophy visualized by imaging with computed tomography, magnetic resonance imaging, or both. Endoscopic ultrasound can assist in making the diagnosis in patients with a high index of suspicion such as recurrent episodes of acute pancreatitis when imaging is normal or equivocal. The first line of therapy consists of advice to discontinue use of alcohol and smoking and taking analgesic agents (nonsteroidal anti-inflammatory drugs and weak opioids such as tramadol). A trial of pancreatic enzymes and antioxidants (a combination of multivitamins, selenium, and methionine) can control symptoms in up to 50% of patients. Patients with pancreatic ductal obstruction due to stones, stricture, or both may benefit from ductal drainage via endoscopic retrograde cholangiopancreatography (ERCP) or surgical drainage procedures, such as pancreaticojejunostomy with or without pancreatic head resection, which may provide better pain relief among people who do not respond to endoscopic therapy. Conclusions and Relevance Chronic pancreatitis often results in chronic abdominal pain and is most commonly caused by excessive alcohol use, smoking, or genetic mutations. Treatment consists primarily of alcohol and smoking cessation, pain control, replacement of pancreatic insufficiency, or mechanical drainage of obstructed pancreatic ducts for some patients.read more
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Journal ArticleDOI
Empfehlungen der zweiten Aktualisierung der Leitlinie LONTS
Winfried Häuser,F. Bock,Michael Hüppe,Monika Nothacker,Heike Norda,Lukas Radbruch,Marcus Schiltenwolf,Matthias Schuler,Thomas R. Tölle,Annika Viniol,Frank Petzke +10 more
TL;DR: The planmasige zweite Aktualisierung der S3-Leitlinie LONTS (Langzeitanwendung of Opioiden bei chronischen nicht-tumorbedingten Schmerzen) [CNTS]), AWMF(Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften)-Registernummer 145-003, wurde ab Dezember 2018 vorgenommen.
Journal ArticleDOI
Mass-forming pancreatitis versus pancreatic ductal adenocarcinoma: CT and MR imaging for differentiation.
Wolfgang Schima,Gernot Böhm,Christiane Sophie Rösch,Alexander Klaus,Reinhold Függer,Helmut Kopf +5 more
TL;DR: The relevant computed tomography (CT) and magnetic resonance imaging (MRI) features that can help the radiologist to come to a confident diagnosis and to guide further management in equivocal cases are summarized.
Journal ArticleDOI
Chronic Pancreatitis: Epidemiology, Diagnosis, and Management Updates
Adam J. Kichler,Sunguk Jang +1 more
TL;DR: The management of patients suffering from chronic pancreatitis often requires a multi-disciplinary approach, addressing pertinent symptoms as well as the sequelae of chronic inflammation and fibrosis.
Journal ArticleDOI
Nationwide epidemiological survey of chronic pancreatitis in Japan: introduction and validation of the new Japanese diagnostic criteria 2019.
Atsushi Masamune,Kazuhiro Kikuta,Kiyoshi Kume,Shin Hamada,Ichiro Tsuji,Yoshifumi Takeyama,Tooru Shimosegawa,Kazuichi Okazaki +7 more
TL;DR: Alcohol-related etiology, smoking history, early disease onset, and past history of AP were associated with the maintenance of early CP diagnosis in DC2019, and the current status of CP in Japan was clarified.
Journal ArticleDOI
TRPV6 variants confer susceptibility to chronic pancreatitis in the Chinese population.
Wen-Bin Zou,Yuan-Chen Wang,Xin‐Lu Ren,Lei Wang,Shun-Jiang Deng,Xiao-Tong Mao,Zhao-Shen Li,Zhuan Liao +7 more
TL;DR: Evidence is provided suggesting that TRPV6 is a novel susceptibility gene for CP, and the entire coding sequence and exon/intron boundaries of the TPRV6 gene were analyzed by Sanger sequencing.
References
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Journal ArticleDOI
CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
TL;DR: This guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.
Journal ArticleDOI
Pancreatitis and the risk of pancreatic cancer
Albert B. Lowenfels,Patrick Maisonneuve,Giorgio Cavallini,Rudolf W. Ammann,Paul Georg Lankisch,Jens Rikardt Andersen,Eugene P. DiMagno,Åke Andrén-Sandberg,Lennart Domellof +8 more
TL;DR: A multicenter historical cohort study of 2015 subjects with chronic pancreatitis who were recruited from clinical centers in six countries finds that pancreatitis may be a risk factor for pancreatic cancer, but the magnitude of the relation between these two diseases is unclear.
Journal ArticleDOI
Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene.
David C. Whitcomb,Michael C. Gorry,Preston Ra,William Furey,Michael Sossenheimer,Charles D. Ulrich,Stephen P. Martin,Lawrence K. Gates,Stephen T. Amann,Phillip P. Toskes,Roger A. Liddle,Kevin McGrath,Generoso Uomo,James Christopher Post,James Christopher Post,Garth D. Ehrlich +15 more
TL;DR: X-ray crystal structure analysis, molecular modelling, and protein digest data indicate that the Arg 117 residue is a trypsin-sensitive site, and that loss of this cleavage site would permit autodigestion resulting in pancreatitis.
Journal ArticleDOI
Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis.
Jonathan A. Cohn,Kenneth J. Friedman,Peadar G. Noone,Michael R. Knowles,Lawrence M. Silverman,Paul S. Jowell +5 more
TL;DR: There was a strong association between mutations in the CFTR gene and pancreatitis, and the abnormal CFTR genotypes in these patients with pancreatitis resemble those associated with male infertility.
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