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Chronic pancreatitis: review and update of etiology, risk factors, and management

Published on May 17, 2018in F1000Research
· DOI :10.12688/f1000research.12852.1
Angela Pham1
Estimated H-index: 1
(UF: University of Florida),
Chris E. Forsmark33
Estimated H-index: 33
(UF: University of Florida)
Sources
Abstract
Chronic pancreatitis is a syndrome involving inflammation, fibrosis, and loss of acinar and islet cells which can manifest in unrelenting abdominal pain, malnutrition, and exocrine and endocrine insufficiency. The Toxic-Metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and Severe Acute Pancreatitis, Obstructive (TIGAR-O) classification system categorizes known causes and factors that contribute to chronic pancreatitis. Although determining disease etiology provides a framework for focused and specific treatments, chronic pancreatitis remains a challenging condition to treat owing to the often refractory, centrally mediated pain and the lack of consensus regarding when endoscopic therapy and surgery are indicated. Further complications incurred include both exocrine and endocrine pancreatic insufficiency, pseudocyst formation, bile duct obstruction, and pancreatic cancer. Medical treatment of chronic pancreatitis involves controlling pain, addressing malnutrition via the treatment of vitamin and mineral deficiencies and recognizing the risk of osteoporosis, and administering appropriate pancreatic enzyme supplementation and diabetic agents. Cornerstones in treatment include the recognition of pancreatic exocrine insufficiency and administration of pancreatic enzyme replacement therapy, support to cease smoking and alcohol consumption, consultation with a dietitian, and a systematic follow-up to assure optimal treatment effect.
  • References (87)
  • Citations (3)
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References87
Newest
#1Claire Johnson Dc MSEd (University Hospital Southampton NHS Foundation Trust)H-Index: 39
#2Rob Arbuckle (Adelphi University)H-Index: 7
Last. Markus M. LerchH-Index: 78
view all 9 authors...
Background Pancreatic exocrine insufficiency (PEI) affects patients with chronic pancreatitis (CP) and cystic fibrosis (CF) who produce insufficient digestive pancreatic enzymes. Common symptoms include steatorrhoea, diarrhea, and abdominal pain.
4 CitationsSource
#1Asbjørn Mohr Drewes (AAU: Aalborg University)H-Index: 57
#2Stefan A.W. Bouwense (Radboud University Nijmegen)H-Index: 12
Last. Dhiraj Yadav (University of Pittsburgh)H-Index: 36
view all 19 authors...
Abdominal pain is the foremost complication of chronic pancreatitis (CP). Pain can be related to recurrent or chronic inflammation, local complications or neurogenic mechanisms with corresponding changes in the nervous systems. Both pain intensity and the frequency of pain attacks have been shown to reduce quality of life in patients with CP. Assessment of pain follows the guidelines for other types of chronic pain, where the multidimensional nature of symptom presentation is taken into consider...
29 CitationsSource
#1Markus K. Diener (Heidelberg University)H-Index: 36
#2Felix J. Hüttner (Heidelberg University)H-Index: 14
Last. Christoph Thomas GermerH-Index: 2
view all 70 authors...
Summary Background There is substantial uncertainty regarding the optimal surgical treatment for chronic pancreatitis. Short-term outcomes have been found to be better after duodenum-preserving pancreatic head resection (DPPHR) than after partial pancreatoduodenectomy. Therefore, we designed the multicentre ChroPac trial to investigate the long-term outcomes of patients with chronic pancreatitis within 24 months after surgery. Methods This randomised, controlled, double-blind, parallel-group, su...
25 CitationsSource
#1John Tillou (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 2
#2Jacob A. Tatum (University of Virginia Health System)
Last. L BraymanKenneth (University of Virginia Health System)H-Index: 41
view all 8 authors...
Abstract Background Pain secondary to chronic pancreatitis is a difficult clinical problem to manage. Many patients are treated medically or undergo endoscopic therapy and surgical intervention is often reserved for those who have failed to gain adequate pain relief from a more conservative approach. Results There have been a number of advances in the operative management of chronic pancreatitis over the last few decades and current therapies include drainage procedures (pancreaticojejunostomy, ...
3 CitationsSource
#1Jeffrey M. Adler (Dartmouth–Hitchcock Medical Center)H-Index: 3
#2Timothy B. Gardner (Dartmouth–Hitchcock Medical Center)H-Index: 33
Chronic pancreatitis is a fibroinflammatory disease of the pancreas leading to varying degrees of endocrine and exocrine dysfunction. Treatment options are generally designed to control the pain of chronic pancreatitis, and endoscopic therapy is one of the main treatment modalities. Herein, we describe the endoscopic management of pancreatic duct calculi and strictures, entrapment of the intrapancreatic bile duct, celiac plexus interventions, and drainage of pancreatic pseudocysts.
5 CitationsSource
#1Jorge D. Machicado (University of Pittsburgh)H-Index: 9
#2Dhiraj Yadav (University of Pittsburgh)H-Index: 36
Emerging data in the past few years suggest that acute, recurrent acute (RAP), and chronic pancreatitis (CP) represent a disease continuum. This review discusses the similarities and differences in the epidemiology of RAP and CP. RAP is a high-risk group, comprised of individuals at varying risk of progression. The premise is that RAP is an intermediary stage in the pathogenesis of CP, and a subset of RAP patients during their natural course transition to CP. Although many clinical factors have ...
23 CitationsSource
#1J.-Matthias Löhr (Karolinska University Hospital)H-Index: 18
Last. Marco J. Bruno (EUR: Erasmus University Rotterdam)H-Index: 58
view all 29 authors...
BackgroundThere have been substantial improvements in the management of chronic pancreatitis, leading to the publication of several national guidelines during recent years. In collaboration with United European Gastroenterology, the working group on ‘Harmonizing diagnosis and treatment of chronic pancreatitis across Europe’ (HaPanEU) developed these European guidelines using an evidence-based approach.MethodsTwelve multidisciplinary review groups performed systematic literature reviews to answer...
74 CitationsSource
#1Adnan Madzak (AAU: Aalborg University)H-Index: 7
#2Trond Engjom (University of Bergen)H-Index: 8
Last. Ingfrid S. Haldorsen (University of Bergen)H-Index: 20
view all 11 authors...
Purpose Secretin-stimulated magnetic resonance imaging (s-MRI) and pancreatic diffusion weighted imaging (DWI) are novel non-invasive imaging techniques for assessment of exocrine pancreatic insufficiency (EPI). The aim was to validate s-MRI assessed pancreatic secreted volume using novel semi-automatic quantification software, and to assess the ability of s-MRI with DWI to diagnose EPI in patients with cystic fibrosis (CF).
9 CitationsSource
#1Alice P. Gu (UT: University of Tennessee)H-Index: 2
#2Chris N. Gu (Mayo Clinic)H-Index: 5
Last. Waleed Brinjikji (Mayo Clinic)H-Index: 39
view all 7 authors...
Abstract Objective To perform a systematic review and meta-analysis to study the magnitude of the placebo effect associated with sham surgery procedures. Study Design and Setting We conducted a systematic search for randomized controlled clinical trials comparing any type of surgery to a corresponding sham placebo group and compared improvements in the sham treatment arms in subjective, objective, categorical, and continuous outcomes, as well as complication rates and mortality. Effect sizes wer...
7 CitationsSource
#1Luis Sabater Ortí (University of Valencia)H-Index: 24
#2Fabio Ausania (University of Vigo)H-Index: 4
Last. Enrique de-MadariaH-Index: 17
view all 26 authors...
Objective:To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery.Background:EPI is a common complication after pancreatic surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and h
25 CitationsSource
Cited By3
Newest
#1Florence Em de Rijk (EUR: Erasmus University Rotterdam)
#2Marinus A. Kempeneers (UvA: University of Amsterdam)H-Index: 4
Last. Robert C. VerdonkH-Index: 16
view all 10 authors...
BACKGROUND AND OBJECTIVE The 2016, United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU) provided evidence-based recommendations for the management of chronic pancreatitis and allowed for the objective evaluation of the quality of care in several domains of disease management through assessment of guideline adherence. Therefore, the aim of this study is to evaluate the current level and the variety of care for chronic pancreati...
Source
#1Caterina Vicentini (University of Verona)H-Index: 15
#2Federica Calore (OSU: Ohio State University)H-Index: 11
Last. Vincenzo Corbo (University of Verona)H-Index: 24
view all 12 authors...
BACKGROUND: Pancreatic and peri-pancreatic neoplasms encompass a variety of histotypes characterized by a heterogeneous prognostic impact. miRNAs are considered efficient candidate biomarkers due to their high stability in tissues and body fluids. We applied Nanostring profiling of circulating exosomal miRNAs to distinct pancreatic lesions in order to establish a source for biomarker development. METHODS: A series of 140 plasma samples obtained from patients affected by pancreatic ductal adenoca...
Source
#1Mikael ParhialaH-Index: 3
#2Juhani SandH-Index: 25
Last. Johanna LaukkarinenH-Index: 17
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Abstract Background /Objectives: In Finland the incidence of chronic pancreatitis (CP) is high compared to that in most European countries. Recent epidemiological data is lacking. Our aim was to investigate the current epidemiologic and behavioural data on CP patients in Finland. Methods CP patients according to M-ANNHEIM criteria in Tampere University Hospital (TAUH) during 2014-2015 were included. Aetiology, time from diagnosis, pancreatic function, treatment, complications, smoking, alcohol c...
1 CitationsSource
#1Friederike Lütt (University of Rostock)
#2Luise Ehlers (University of Rostock)H-Index: 2
Last. Robert Jaster (University of Rostock)H-Index: 26
view all 4 authors...
Abstract BACKGROUND Current animal models of chronic pancreatitis (CP) often provide only limited pathophysiological insights since they incompletely reflect the human disease. CP induced by injection of dibutyltin dichloride (DBTC-pancreatitis) shares with human CP the important feature of extended fibrosis and would be an even more attractive model if it could be transferred from rats to mice, as recently suggested in the context of combined ethanol and DBTC application. This study aimed to ev...
Source
#1Kaveh Sharzehi (OHSU: Oregon Health & Science University)H-Index: 1
Purpose of Review Pancreatic duct stones are sequela of chronic pancreatitis. They can cause pancreatic duct obstruction which is the most important cause of pain in chronic pancreatitis. Stone resolution has shown to improve pain. The goal of this review is to highlight recent endoscopic and surgical advancements in treatment of pancreatic duct stones.
Source
#1Yaseen B. Perbtani (UF: University of Florida)H-Index: 7
#2Chris E. Forsmark (UF: University of Florida)H-Index: 33
Exocrine pancreatic insufficiency (EPI) is characterized by inadequate pancreatic enzyme delivery to the small intestine Exocrine pancreatic insufficiency (EPI) is characterized by inadequate pancreatic enzyme delivery to the small intestine, resulting in malabsorption. Clinical manifestations of EPI are often nonspecific and can lead to lack of timely recognition and diagnosis. Central to this clinical dilemma is the lack of highly accurate or specific testing which leads to misdiagnosis and su...
1 CitationsSource
#1Ahmed Abdel Khalek Abdel Razek (Mansoura University)H-Index: 36
#2Elsayed ElfarH-Index: 1
Last. Shefeek AbubackerH-Index: 2
view all 3 authors...
Aim To assess the interobserver agreement of computed tomography (CT) reporting standards for chronic pancreatitis (CP).
3 CitationsSource
#2Søren Schou OlesenH-Index: 24
Last. Jens Brøndum FrøkjærH-Index: 28
view all 6 authors...
Introduction The management of chronic pancreatitis (CP) is challenging and requires a personalised approach focused on the individual patient’s main symptoms. Abdominal pain is the most prominent symptom in CP, where central pain mechanisms, including sensitisation and impaired pain modulation, often are involved. Recent clinical studies suggest that vagal nerve stimulation (VNS) induces analgesic effects through the modulation of central pain pathways. This study aims to investigate the effect...
Source
#1Carlo Frola (Royal London Hospital)H-Index: 1
#2Murali Somasundaram (Royal London Hospital)H-Index: 1
Last. V.S. Yip (Royal London Hospital)H-Index: 5
view all 7 authors...
Background Chronic pancreatitis (CP) remains a complex condition resulting in significant morbidity and suffering in patients, often over a long period of time. Treatment is mostly centred on a conservative approach, with a variety of more aggressive options being trialled over the years utilising numerous endoscopic and surgical techniques.
1 CitationsSource