Management Of Chronic Pancreatitis Research Articles

Pain in chronic pancreatitis: What can we do today?

The aim of this study is to illustrate the complexity of pain management in chronic pancreatitis (CP). In this context, pain represents the most common and debilitating symptom, and it deeply affects patient's quality of life. Multiple rating scales (unidimensional, bidimensional and multidimensional) have been proposed to quantify CP pain. However, it represents the result of complex mechanisms, involving genetic, neuropathic and neurogenic factors. Considering all these aspects, the treatment should be discussed in a multidisciplinary setting and it should be approached in a stepwise manner. First, a lifestyle change is recommended and nonsteroidal anti-inflammatory drugs represent the gold standard among medical treatments for CP patients. The second step, after medical approach, is endoscopic therapy, especially for complicated CP. In case of failure, tailored surgery represents the third step and decompressive or resection procedures can be chosen. In conclusion, CP pain's management is challenging considering all these complex aspects and the lack of international protocols.

Assesment of Pain Management in Chronic Pancreatitis after Lateral Pancreatico Jejunostomy

Background: The main symptom of chronic pancreatitis is pain, which is treated via lateral pancreaticojejunostomy (LPJ) to relieve symptoms. Patients with dilated pancreatic ducts and excruciating pain are treated with it. Slowing the disease's course and providing optimal pain relief can be accomplished through surgical decompression of the duct and ductal drainage. Objective: The aim of this study is to assessment of pain management in chronic pancreatitis after lateral pancreatico jejunostomy. Methods: The cross-sectional observational study was conducted in the department of Surgery, Avicenna hospital limited, Sirajganj, Bangladesh, from October 2022 to September 2023. A total of 90 patients who underwent lateral pancreatico jejunostomy for patients with chronic pancreatitis were included in the study. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, with a range from 20 to 70 years, maximum 36 (40.0%) of the patients were within the age group of 31 - 40 years and minimum 5 (5.6%) of the patients were in the age 61 - 70 years and most of the patients 56 (62.20%) were male and 34 (37.80%) patients were female. Most of the patients 46 (51.1%) came from middle-income families. The majority of respondents had history of smoking 53 (58.90%) and 37 (41.10%) were nonsmoker. The majority of respondents had no history of alcohol intake 66 (73.30%) and 24 (26.70%) were alcoholic. Among total population 58 (64.40%) had diabetes mellitus and 32 (35.6%) did not had diabetes mellitus. Majority of the respondents had upper abdominal pain (100%) followed in decreasing order by nausea/vomiting 68 (75.6%), history of weight loss 61 (67.80%), fatigue 47 (52.2%), fever 37(41.10%), steatorrhoea 35(38.90%), diarrhoea 29(32.20%) and shortness of breath 21(23.30%). Majority of the ..

Assesment of pain management in chronic pancreatitis after lateral pancreatico-jejunostomy: A comparative analysis of pre and post operative outcomes

Assesment of pain management in chronic pancreatitis after lateral pancreatico-jejunostomy: A comparative analysis of pre and post operative outcomes

The Role of a Cholecystokinin Receptor Antagonist in the Management of Chronic Pancreatitis: A Phase 1 Trial.

Chronic pancreatitis (CP) is a rare but debilitating condition with an 8-fold increased risk of developing pancreatic cancer. In addition to the symptoms that come from the loss of endocrine and exocrine function in CP, the management of chronic pain is problematic. We previously showed that the CCK-receptor antagonist called proglumide could decrease inflammation, acinar-ductal metaplasia, and fibrosis in murine models of CP. We hypothesized that proglumide would be safe and diminish pain caused by CP. A Phase 1 open-labeled safety study was performed in subjects with clinical and radiographic evidence of CP with moderate to severe pain. After a 4-week observation period, the subjects were treated with proglumide in 400 mg capsules three times daily (1200 mg per day) by mouth for 12 weeks, and then subjects returned for a safety visit 4 weeks after the discontinuation of the study medication. The results of three pain surveys (Numeric Rating Scale, COMPAT-SF, and NIH PROMIS) showed that the patients had significantly less pain after 12 weeks of proglumide compared to the pre-treatment observation phase. Of the eight subjects in this study, two experienced nausea and diarrhea with proglumide. These side effects resolved in one subject with doses reduced to 800 mg per day. No abnormalities were noted in the blood chemistries. A blood microRNA blood biomarker panel that corresponded to pancreatic inflammation and fibrosis showed significant improvement. We conclude that proglumide is safe and well tolerated in most subjects with CP at a dose of 1200 mg per day. Furthermore, proglumide therapy may have a beneficial effect by decreasing pain associated with CP.

Pain management in chronic pancreatitis

Pain in chronic pancreatitis (CP) is difficult to manage. Many patients suffer from inadequate pain relief, completely incapacitating them in their daily activities. Historically, despite their well-known adverse effects, opioids have been the pillar of treatment regimens in painful CP. The management is now gradually evolving with a better understanding of the underlying pathophysiology of CP-related pain. Clinicians should follow a holistic approach to the management of CP-associated pain, which must involve lifestyle changes that are coupled with analgesic medications and other pain-relieving interventions. Furthermore, there is no easy cure for vanquishing CP-associated pain. Each patient must be evaluated on a case-by-case basis by a multidisciplinary team to decide which treatment option is best suited for that individual.

Considering Frey’s procedure as primary surgical management in chronic pancreatitis and pancreatic stone: A case report

Chronic pancreatitis (CP) is characterized by abdominal pain, recurrent acute pancreatitis episodes, and pancreatic fibrosis, which leads to endocrine and exocrine insufficiency. Back in 1987, Frey and Smith demonstrated pancreatic head anterior resection combined with drainage of the main pancreatic duct using pancreaticojejunostomy. A 52-year-old man complained of right upper abdominal pain for 2 weeks. MRI examination presented prominent dilatation of the left and right intrahepatic ducts, and common bile duct due to the main pancreatic duct massive dilatation, accompanied by an irregular filling defect that adhesions to the wall, suggesting pancreatic stones. The patient was diagnosed with chronic calcifying pancreatitis with pancreatic stones. Frey’s procedure was chosen as primary surgical management. When conservative therapy fails to relieve the pain from chronic pancreatitis, physicians should consider surgery as a primary intervention. We recommend Frey's procedure for chronic pancreatitis treatment because of its safety and effectiveness.

Management of chronic pancreatitis: recent advances and future prospects.

As a progressive fibroinflammatory disease, chronic pancreatitis (CP) often manifests as recurrent bouts of abdominal pain with or without complications, causing a heavy burden of health care. In recent years, some meaningful insights into the management of CP have been obtained from randomized controlled trials, systematic reviews, and meta-analyses, which were of great importance. Based on this research, it is shown that there are various treatments for CP. Therefore, it is of great importance to choose a suitable strategy for patients with CP individually. Relevant evidence on the management of CP was summarized in this review, including nutrition supplements, medication, endoscopy, surgery, exploration of novel therapies as well as evaluation and prediction of treatment response.

Management of chronic pancreatitis

Management of chronic pancreatitis

Adjunctive incremental pregabalin therapy versus placebo for pain management in chronic pancreatitis: a randomized controlled trial

Adjunctive incremental pregabalin therapy versus placebo for pain management in chronic pancreatitis: a randomized controlled trial

S133 Long-Term Outcomes of ERCP in the Management of Chronic Pancreatitis Over a 10-year Period at a Tertiary Care Center

S133 Long-Term Outcomes of ERCP in the Management of Chronic Pancreatitis Over a 10-year Period at a Tertiary Care Center

Scope of Homoeopathy in The Management of Chronic Pancreatitis – A Case Report

Scope of Homoeopathy in The Management of Chronic Pancreatitis – A Case Report

Clinical Profile, Etiology and Role of Endotherapy in Chronic Calcific Pancreatitis: An Experience from North India.

Background: In recent years, we have witnessed an evolving landscape in the management of chronic pancreatitis (CP). Endoscopy plays a pivotal role in CP management. Because the management of CP is problematic, we aimed to review and evaluate the role of endoscopy in the management of CP. Methods: This study was carried out in patients with painful chronic calcific pancreatitis who were admitted to the Department of Gastroenterology at the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar. This was an observational prospective study. We included 67 patients with painful chronic calcific pancreatitis and pancreatic duct abnormalities (stones, strictures, or ductal variations) in our study. These patients had to access exocrine and endocrine status before any therapeutic measures. All the patients underwent endoscopic retrograde cholangiopancreatography (ERCP) as a therapeutic measure. After ERCP, the patients were followed up for 2 years to assess improvement in pain (visual analog scale score reduction), endocrine status (HBA1C reduction), or exocrine status (Fecal elastase reduction). Results: 67 patients were included in the study. Among them males were 32 (47.8%), females were 35(52.5%) and the age distribution studied were as in the age group of 15-30 years, patients were 23 (34.3%), in 30-45 years, there was 20 (29.9%), in age group of 45-60 year, patients were 20 (29.9%), and in the age group of 60-75 years, the patients were 4 (6%). Etiology was sought in all patients; alcohol-related CP was seen in three patients (4.5%), genetic in 11 (16.4%), IgG4 in one (1.5%), pancreatic divisum in 6 (9.0%), hyperparathyroidism in on1e (1.5%), and idiopathic in 45 (67.2%). All patients underwent ERCP for their symptoms to reduce ductal pressure, which is postulated as one of the hypotheses for pain in CP. Pancreatic duct (PD) clearance was attempted in all patients (complete in 42 [62.7%], partial in 17 [25.4%], and failed in 8 [11.9%]). These patients were followed for a period of two years after endotherapy, and the important predictors for pain reduction were single PD stones, disease in the head and body, and non-stricturing disease. Conclusion: Endotherapy offers a high rate of success in selected patients, clearance being better in distal disease and CP without PD strictures, suggesting early disease usually gets cleared very easily.

Psychological Evaluation and Management of Chronic Pancreatitis.

Chronic pancreatitis is a chronic digestive disorder that greatly diminishes the quality of life and is associated with significant psychological distress. A best practice recommendation in treating chronic pancreatitis is offering care in a multidisciplinary model that includes access to a behavioral health provider among other medical professionals. Behavioral interventions for patients with chronic pancreatitis have promise to improve the management of pain, comorbid psychiatric symptoms, and quality of life. If surgical interventions such as a total pancreatectomy islet autotransplant are considered, evaluating and mitigating psychosocial risk factors may aid the selection of appropriate candidates.

Revisiting Dietary Approaches in the Management of Chronic Pancreatitis

Revisiting Dietary Approaches in the Management of Chronic Pancreatitis

Clinical Profile and Management of Chronic Pancreatitis in Tertiary Care Centre

Background Constant inflammation and irreversible pancreatic tissue destruction are hallmarks of the disease of chronic pancreatitis (CP), which results in the decrease of both exocrine and endocrine function over time. It is a multifactorial disease, with a wide range of symptoms and geographic variation. Aim Aim of this study is to study clinical profile and management of CP with respect to demography, clinical findings, lab parameters, imaging investigations and management modalities. Methods A cross-sectional observational study was conducted which included the patients admitted to the tertiary care center presenting with the clinical diagnosis of CP. The study was conducted over a period of 2-years from November 2019 to October 2021. A total sample size of 71 patients was included. Results In the study, it was observed that the majority of patients were in the age group of 51-60-years (47.89%) followed by 41-50-years (21.12%) mean age ranges from 56.54±12.63-years. The majority of patients were male (76.06%) and females were 23.94%. The distribution of patients according to aetiology showed that the majority of patients had aetiology of alcoholism (43.66%) followed by idiopathic (29.57%) Gall/Biliary stones (21.12%) and post-operative (5.63%). Majority of patients presented with pain in the abdomen (85.92%). The distribution of patients according to ultrasound sonography test (USG) findings showed that majority of patients shows pancreatic calcification (54.93%) followed by pancreatic pseudocyst (32.39%) and gall stones (19.72%). The distribution of patients according to computed tomography (CT) findings showed that majority of patients shows pancreatic calcification (70.42%). In the present study, it was observed that majority of patients were managed conservatively (43.66%) followed by cystogastrostomy (18.31%) and cystojejunostomy (8.45%). Endoscopic retrograde cholangiopancreatography (ERCP) was done among 14 (19.72%) patients. Lateral pancreaticojejunostomy was done in 6 (8.45%) patients and pancreaticoduodenectomy (Classical Whipple’s) was done in 4 patients (5.63%). The distribution of patients according to pain relief by various management showed that majority of getting relief from pain by surgery (69.23%) followed by ERCP (35.71%) and the least by conservative/analgesics (6.45%). Conclusion Chronic pancreatitis is progressive inflammatory disease. Alcoholic pancreatitis being most common etiology. Pain is most common presenting symptom. CT scan abdomen most useful in confirming diagnosis in our set up. Pseudocyst being common complication seen. Surgery gives relief of pain in most of the cases. The key to a better outcome is making the right decisions in terms of diagnosis, patient selection for surgery, and surgical type.

Preliminary results of laparoscopic management of chronic pancreatitis

Preliminary results of laparoscopic management of chronic pancreatitis

Clinical profile and management of chronic pancreatitis in tertiary care centre

Background: Chronic pancreatitis is a multifactorial disease, with a wide range of symptoms and geographic variation. Aim of this study is to study clinical profile and management of chronic pancreatitis with respect to demography, clinical findings, lab parameters, imaging investigations and management modalities.Methods: A cross sectional observational study was conducted which included the patients admitted in tertiary care centre presenting with clinical diagnosis of chronic pancreatitis. The study was conducted over period of 2 years from November 2019 to October 2021. A total sample size of 71 patients were included.Results: In the study, it was observed that majority of patients in age group of 51-60 years which were male (76.06%). Alcoholism (43.66%) was most common etiology and presented with pain in abdomen (85.92%). In the present study, majority of patients were managed conservatively (43.66%).The distribution of patients according to pain relief by various management showed that majority of get relief of pain by surgery (69.23%).Conclusions: Chronic pancreatitis is progressive inflammatory disease. Alcoholic pancreatitis being most common etiology. Pain is most common presenting symptom. CT-SCAN abdomen most useful in confirming diagnosis in our set up. Pseudocyst being common complication seen. Surgery gives relief of pain in most of the cases.

The Role of Surgical Management in Chronic Pancreatitis in Children: A Position Paper From the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee.

Chronic pancreatitis (CP) is rare in childhood but impactful because of its high disease burden. There is limited literature regarding the management of CP in children, specifically about the various surgical approaches. Herein, we summarize the current pediatric and adult literature and provide recommendations for the surgical management of CP in children. The literature review was performed to include the scope of the problem, indications for operation, conventional surgical options as well as total pancreatectomy with islet autotransplantation, and outcomes following operations for CP. Surgery is indicated for children with debilitating CP who have failed maximal medical and endoscopic interventions. Surgical management must be tailored to the patient's unique needs, considering the anatomy and morphology of their disease. A conventional surgical approach (eg, drainage operation, partial resection, combination drainage-resection) may be considered in the presence of significant and uniform pancreatic duct dilation or an inflammatory head mass. Total pancreatectomy with islet autotransplantation is the best surgical option in patients with small duct disease. The presence of genetic risk factors often portends a suboptimal outcome following a conventional operation. The morphology of disease and the presence of genetic risk factors must be considered while determining the optimal surgical approach for children with CP. Surgical outcomes for CP are variable and depend on the type of intervention. A multidisciplinary team approach is needed to assure that the best possible operation is selected for each patient, their recovery is optimized, and their immediate and long-term postoperative needs are well-met.

The Optimal Length of Pancreatic Dochotomy in Frey's Procedure Based on Intraoperative Pancreatoscopy

Introduction: Surgery is the cornerstone of the treatment of chronic pancreatitis that is refractory to medical management. Frey's procedure is a commonly performed surgery in the management of chronic pancreatitis. This study aims to describe the optimal length of the pancreatic dochotomy based on intraoperative pancreatoscopy.

Epidemiology and Characteristics of Chronic Pancreatitis-Do the East and West Meet?

Previous large studies on the epidemiology and clinical profile of chronic pancreatitis have suggested significant differences in presentation and management in the eastern and western hemispheres. The aim of this systematic review was to compare large multicenter studies across different geographic regions of the world to detect meaningful differences in the presentation and management of this poorly understood disease. We identified 237 manuscripts through a comprehensive literature review aiming to identify multicenter studies enrolling more than 200 patients to limit reporting biases. After rigorous screening, 12 studies were included for the final analysis. The Asian studies were included in the eastern cohort, and the European and American studies were included in the western cohort. Reported demographics, risk factors, etiologies, clinical presentation, complications, and management strategies were then compared. We found similar demographics across both cohorts including age, prevalence among gender, and predominant etiology. Clinical manifestations including pain, pancreatic calcifications, and diabetes were similar between both cohorts although pseudocysts, pancreatic cancer, and strictures were more common in the west. Notably opioids and surgical/endotherapy management were more common in the west as well. Chronic pancreatitis is a protracted disease affecting predominantly middle-aged people, leading to a decreased quality of life. Chronic pancreatitis now appears to have a fairly similar clinical profile and natural history in the east and west. There is notable variability in management. We hope that international collaboration may identify common targets for research which could lead to significant advances in the understanding and management of chronic pancreatitis.