Quality Of Life In Chronic Pancreatitis Research Articles

Pain Management in Chronic Pancreatitis: Summary of Clinical Practice, Current Challenges and Potential Contribution of the M-ANNHEIM Classification.

Abdominal pain, diarrhea with weight loss, and endocrine insufficiency represent the dominant symptoms of chronic pancreatitis (CP). High intensity of pain and constant pain have been shown to reduce quality of life in CP and may result in disability and increased health resource utilization. Various basic challenges and unanswered questions still exist regarding the treatment of pain in CP. Recently, limited evidence has been gained that early surgery for painful disease might be associated with better treatment results. Thus, timing of pancreatic surgery in painful disease represents a major issue that needs to be clarified in future studies. In this context, surveillance of patients is necessary in clinical practice. It appears that a generally accepted classification of the disease represents a major requirement for inter-institutional comparison of data with future progress in clinical research. Among recently proposed classification systems, the M-ANNHEIM classification system of CP with its recently presented M-ANNHEIM Surgery Score might be a useful tool to picture the course of the disease and to monitor treatment results. Future research is required to clarify the possible role of this system in the management of pain in CP. In the present article, we provide an overview of current status, challenges, and unanswered questions in the treatment of pain in CP, and we demonstrate the potential benefits of the M-ANNHEIM classification system in the management of painful CP.

Psychiatric Comorbidity in Patients With Chronic Pancreatitis Associates With Pain and Reduced Quality of Life.

Abdominal pain, frequent in patients with chronic pancreatitis (CP), has a negative impact on quality of life (QOL). Psychiatric comorbidities including anxiety and depression are associated with pain, but their prevalence and effects on QOL in CP have not been quantified. We studied the prevalence of anxiety and depression in patients with CP and their associated patient and disease characteristics and impact on QOL. This was a cross-sectional, multicenter prospective study. Patients were screened with the Hospital Anxiety and Depression Scale questionnaire. A Hospital Anxiety and Depression Scale score >7 on the respective anxiety or depression subscales indicated the presence of anxiety or depression and was used as a surrogate for the diagnosis of psychiatric comorbidities. Patient demographics, disease characteristics, QOL (EORTC-QLQ-C30), and pain symptoms (Brief Pain Inventory Short Form) were compared between patients with and without psychiatric comorbidities. One hundred seventy-one patients with CP (mean age 53.8 ± 13.7 years, 60% men) were included. Anxiety and depression were present in 80 (46.8%) and 66 (38.6%) patients, with overlap in 50 (29%). Patients with anxiety or depression reported higher pain prevalence, pain severity, and pain interference scores (all P < 0.001). Psychiatric comorbidities also associated with reduced global health scores and functional subscales (all P < 0.001) and higher symptom burden (P ≤ 0.03). An independent association was noted between global health status and depression (P < 0.001). Psychiatric comorbidities are prevalent in patients with CP and associated with pain and QOL. Where the effect of anxiety on QOL may be mediated via pain, depression is independently related to QOL. These findings warrant consideration in the management of patients with CP.

Beyond Abdominal Pain: Pain Beliefs, Pain Affect, and Distress as Determinants of Quality of Life in Patients With Chronic Pancreatitis.

To assess the relationship between pain, psychological processes, and quality of life (QOL) in chronic pancreatitis (CP). CP is a progressive inflammatory disorder of the pancreas characteristically resulting in abdominal pain and impairing QOL. Pain due to CP is poorly understood and frequently difficult to treat. This pain has historically been understood as a peripheral process originating from the pancreas itself, but a growing body of literature is revealing an important role offered by central influences. Viewed through the perspective of the biopsychosocial model of illness, cognitive variables strongly influence QOL. However, there is little understanding of variables that influence QOL in CP. Patients with CP from the University of Alabama at Birmingham were administered a 165-question test battery which was comprised of questionnaires evaluating pain beliefs, disease-specific QOL, psychological distress, pain sensation, pain affect, and long-term suffering. Sixty-eight subjects completed the question battery between February 28, 2011 and January 16, 2014. Almost all (91.2%) reported taking pain medication. QOL was significantly associated with reported levels of pain intensity (r=-0.52, P<0.01) as well as perceived self-blame. The significant predictors of QOL impairment in CP are pain intensity and perceived self-blame for pain. Further research is needed to elucidate this relationship while also evaluating the effectiveness of systematic modification of these variables in an attempt to improve pain and QOL in CP.

Quality of Life in Chronic Pancreatitis is Determined by Constant Pain, Disability/Unemployment, Current Smoking, and Associated Co-Morbidities.

Chronic pancreatitis (CP) has a profound independent effect on quality of life (QOL). Our aim was to identify factors that impact the QOL in CP patients. We used data on 1,024 CP patients enrolled in the three NAPS2 studies. Information on demographics, risk factors, co-morbidities, disease phenotype, and treatments was obtained from responses to structured questionnaires. Physical and mental component summary (PCS and MCS, respectively) scores generated using responses to the Short Form-12 (SF-12) survey were used to assess QOL at enrollment. Multivariable linear regression models determined independent predictors of QOL. Mean PCS and MCS scores were 36.7±11.7 and 42.4±12.2, respectively. Significant (P<0.05) negative impact on PCS scores in multivariable analyses was noted owing to constant mild-moderate pain with episodes of severe pain or constant severe pain (10 points), constant mild-moderate pain (5.2), pain-related disability/unemployment (5.1), current smoking (2.9 points), and medical co-morbidities. Significant (P<0.05) negative impact on MCS scores was related to constant pain irrespective of severity (6.8-6.9 points), current smoking (3.9 points), and pain-related disability/unemployment (2.4 points). In women, disability/unemployment resulted in an additional 3.7 point reduction in MCS score. Final multivariable models explained 27% and 18% of the variance in PCS and MCS scores, respectively. Etiology, disease duration, pancreatic morphology, diabetes, exocrine insufficiency, and prior endotherapy/pancreatic surgery had no significant independent effect on QOL. Constant pain, pain-related disability/unemployment, current smoking, and concurrent co-morbidities significantly affect the QOL in CP. Further research is needed to identify factors impacting QOL not explained by our analyses.

PWE-217 Pancreatic enzyme replacement therapy in chronic pancreatitis and pancreatic cancer – are we getting it right?: Abstract PWE-217 Table 1

<h3>Introduction</h3> Pancreatic enzyme insufficiency (PEI) is a well recognised cause of malnutrition in chronic pancreatitis and pancreatic cancer. Pancreatic enzyme replacement therapy (PERT) in the form of enteric coated pancreatin microspheres is recommended in both these groups of patients with symptoms of PEI to prevent weight loss and malnutrition and improve quality of life. Given that the probability of PEI is high in PC (80–90%), PERT is recommended without the use of formal diagnostic tests. The optimal starting dose of PERT is 40–50000 lipase units per main meal. The aim of this study was to evaluate the use of PERT including appropriate dosing in chronic pancreatitis (CP) and pancreatic cancer (PC) and to ascertain if there was a difference in prescribing practice between these groups. <h3>Method</h3> A single centre retrospective analysis of patients diagnosed with CP and PC since 2010 in a large North London district general hospital was performed using local upper gastrointestinal cancer multidisciplinary team records and clinical coding. We identified 149 patients with PC and 110 with CP though 32 patients from the PC group and 4 from CP were excluded from the study due to poor documentation in the records leading to insufficient information surrounding enzyme supplementation and dosages. Information was collected from electronic patient records on the patients’ symptoms, evidence of PERT and the dose prescribed. <h3>Results</h3> Symptoms of pancreatic enzyme insufficiency (abdominal pain, weight loss or steatorrhoea) were recorded in 72/117 (61.5%) of PC patients compared with 75/106 (70.8%) of CP patients. PERT was prescribed in 14/72 (19.5%) patients with PC versus 53/75 (70.7%) with CP. The Table 1shows the enzyme formulation and dosages used in both groups. <h3>Conclusion</h3> In our study we demonstrate that the majority of patients with PEI in CP are prescribed PERT, a stark contrast with a mere 20% in PC. However in both groups, most patients were not prescribed optimal doses of PERT though again, this figure was better in the CP group (14/53 or 26.4%) compared to the PC group (2/14 or 14.3%). This study highlights the missed opportunity to reduce symptoms and improve quality of life in CP and PC patients with a simple intervention. Increased awareness of the availability and appropriate dosing of PERT in conditions resulting in PEI is required. <h3>Disclosure of interest</h3> None Declared.

Su1888 Pancreatic Enzyme Replacement Therapy in Chronic Pancreatitis and Pancreatic Cancer- Are We Getting It Right?

Introduction Pancreatic enzyme insufficiency (PEI) is a well recognised cause of malnutrition in chronic pancreatitis and pancreatic cancer. Pancreatic enzyme replacement therapy (PERT) in the form of enteric coated pancreatin microspheres is recommended in both these groups of patients with symptoms of PEI to prevent weight loss and malnutrition and improve quality of life. Given that the probability of PEI is high in PC (80–90%), PERT is recommended without the use of formal diagnostic tests. The optimal starting dose of PERT is 40–50000 lipase units per main meal. The aim of this study was to evaluate the use of PERT including appropriate dosing in chronic pancreatitis (CP) and pancreatic cancer (PC) and to ascertain if there was a difference in prescribing practice between these groups. Method A single centre retrospective analysis of patients diagnosed with CP and PC since 2010 in a large North London district general hospital was performed using local upper gastrointestinal cancer multidisciplinary team records and clinical coding. We identified 149 patients with PC and 110 with CP though 32 patients from the PC group and 4 from CP were excluded from the study due to poor documentation in the records leading to insufficient information surrounding enzyme supplementation and dosages. Information was collected from electronic patient records on the patients’ symptoms, evidence of PERT and the dose prescribed. Results Symptoms of pancreatic enzyme insufficiency (abdominal pain, weight loss or steatorrhoea) were recorded in 72/117 (61.5%) of PC patients compared with 75/106 (70.8%) of CP patients. PERT was prescribed in 14/72 (19.5%) patients with PC versus 53/75 (70.7%) with CP. The Table 1shows the enzyme formulation and dosages used in both groups. Conclusion In our study we demonstrate that the majority of patients with PEI in CP are prescribed PERT, a stark contrast with a mere 20% in PC. However in both groups, most patients were not prescribed optimal doses of PERT though again, this figure was better in the CP group (14/53 or 26.4%) compared to the PC group (2/14 or 14.3%). This study highlights the missed opportunity to reduce symptoms and improve quality of life in CP and PC patients with a simple intervention. Increased awareness of the availability and appropriate dosing of PERT in conditions resulting in PEI is required. Disclosure of interest None Declared.

Physical and Mental Quality of Life in Chronic Pancreatitis

The objective of this study was to define the quality of life (QOL) in patients with chronic pancreatitis (CP).We studied 443 well-phenotyped CP subjects and 611 control subjects prospectively enrolled from 20 US centers between 2000 and 2006 in the North American Pancreatitis Study 2. Responses to the SF-12 questionnaire were used to calculate the mental (MCS) and physical component summary scores (PCS) with norm-based scoring (normal ≥50). Quality of life in CP subjects was compared with control subjects after controlling for demographic factors, drinking history, smoking, and medical conditions. Quality of life in CP was also compared with known scores for several chronic conditions.Both PCS (38 [SD, 11.5] vs 52 [SD, 9.4]) and MCS (44 [SD, 11.5] vs 51 [SD, 9.2]) were significantly lower in CP compared with control subjects (P < 0.001). On multivariable analyses, compared with control subjects, a profound decrease in physical QOL (PCS 12.02 points lower) and a clinically significant decrease in mental QOL (MCS 4.24 points lower) was seen due to CP. Quality of life in CP was similar to (heart, kidney, liver, lung disease) or worse than (nonskin cancers, diabetes mellitus, hypertension, rheumatoid arthritis) other chronic conditions.The impact of CP on QOL appears substantial. The QOL in CP subjects appears to be worse or similar to the QOL of many other chronic conditions.

M1381 Use and Helpfulness of Mechanism-Targeted Medical Pain Therapies in Chronic Pancreatitis

AIM: SF-36 Health Survey is a generic questionnaire designed as an assessment method of health status, using 36 questions that are grouped in eight scales: physical functioning (PF), role physical functioning (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional functioning (RE), and mental health (MH). This study was designed to examine the quality of life (QOL) in patients with chronic pancreatitis (CP) of varying severity, and to determine the factors associated with poor physical and mental health. Material and method: We studied 104 pacients, (93.2% male and 6.8% female) from a tertiary care gastroenterology clinic. The diagnosis of chronic pancreatitis was made by a combination of morphologic, functional, and clinical findings. Data were obtained either by face-to-face interview (31%) or by telephone (69%). Results: The scale scores of PF, RP, BP, GH, VT, SF, RE, and MH were as follows: 58.7, 65.1, 77.6, 65.7, 54.4, 53.6, 69.4, and 66.9. When compared to the general population (values of mean SF-36 scores published 8 years ago by The National Institute of Statistics), all domains of health-related quality of life were reduced in CP, mainly in witch concernes PF (p=0.08), symptoms' severity (p=0.005) and the cognitive function impairment (p=0.004). Furthermore, regarding the severity of CP assessed by imagistic (CT, EUS and ERCP) and functional means (fecal elastase test), the 64 (61,7%) patiens meeting the stage III Cambridge criteria scored significantly worse then those in stage II (n=28, 27.1%); or I (n=12,11.1%) (p<0.005). Out of the various variables that we considered as possible factors related to CP (pancreatic calcifications, Wirsung duct dilatation, pseudocysts, pancreatic insufficiency, diabetes), only pain significantly impaired all eight domains (ANOVA, p< 0.0005 for all scales). Regarding the changes in pancreatic morphology, main pancreatic duct dilatation was the element that influenced the most QOL in CP. Patients presenting Between clinical variables patients presenting diabetes mellitus, pancreatic insufficiency and BMI < 19 scored worse mainly for physical domains Conclusion: Patients with CP presented an impaired QOLwitch wasmore important in the physical component than in the mental component. In our study, pain was the clinical element that impaired all 8 domain of SF-36, whereas pancreatic morphological changes, and other clinical elements influenced only some of these domains.

M1382 Nutritional Assessment of Patients With Chronic Pancreatitis and Impact of Dietary Advice

AIM: SF-36 Health Survey is a generic questionnaire designed as an assessment method of health status, using 36 questions that are grouped in eight scales: physical functioning (PF), role physical functioning (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional functioning (RE), and mental health (MH). This study was designed to examine the quality of life (QOL) in patients with chronic pancreatitis (CP) of varying severity, and to determine the factors associated with poor physical and mental health. Material and method: We studied 104 pacients, (93.2% male and 6.8% female) from a tertiary care gastroenterology clinic. The diagnosis of chronic pancreatitis was made by a combination of morphologic, functional, and clinical findings. Data were obtained either by face-to-face interview (31%) or by telephone (69%). Results: The scale scores of PF, RP, BP, GH, VT, SF, RE, and MH were as follows: 58.7, 65.1, 77.6, 65.7, 54.4, 53.6, 69.4, and 66.9. When compared to the general population (values of mean SF-36 scores published 8 years ago by The National Institute of Statistics), all domains of health-related quality of life were reduced in CP, mainly in witch concernes PF (p=0.08), symptoms' severity (p=0.005) and the cognitive function impairment (p=0.004). Furthermore, regarding the severity of CP assessed by imagistic (CT, EUS and ERCP) and functional means (fecal elastase test), the 64 (61,7%) patiens meeting the stage III Cambridge criteria scored significantly worse then those in stage II (n=28, 27.1%); or I (n=12,11.1%) (p<0.005). Out of the various variables that we considered as possible factors related to CP (pancreatic calcifications, Wirsung duct dilatation, pseudocysts, pancreatic insufficiency, diabetes), only pain significantly impaired all eight domains (ANOVA, p< 0.0005 for all scales). Regarding the changes in pancreatic morphology, main pancreatic duct dilatation was the element that influenced the most QOL in CP. Patients presenting Between clinical variables patients presenting diabetes mellitus, pancreatic insufficiency and BMI < 19 scored worse mainly for physical domains Conclusion: Patients with CP presented an impaired QOLwitch wasmore important in the physical component than in the mental component. In our study, pain was the clinical element that impaired all 8 domain of SF-36, whereas pancreatic morphological changes, and other clinical elements influenced only some of these domains.

Clinical, Emotional and Social Factors Associated with Quality of Life in Chronic Pancreatitis

Background: In chronic pancreatitis (CP), a debilitating, progressive and incurable disease, patients' wellbeing is considerably impaired, butthedifferentfactorsaffecting quality of life (QoL), have not been identified yet. Methods: 69 patients with CP were evaluated (M/F 55/14; mean age 46.6 ± 10.05 years). Different degrees of pancreatic damage were defined using the Cambridge classification; pain intensity and frequency were assessed using pain index. QoL was measured using EORTC QLQ-C30 and the PAN26 questionnaire. Although developed for pancreatic cancer, the C30/PAN26 has been validated for chronic pancreatitis. Results: Digestive symptoms, financial difficulties, fear of future health and general pain scales showed considerable effects of CP on QoL. We observed significant negative correlation between mean QoL scores and pain index in almost all domains (p< 0.001, p<0.05). Pain intensity affects QoL scales more often than pain frequency. BMI correlated positively with QoL in global health status, altered bowel habits, body image and satisfaction with health care domains (p<0.01, p<0.05). Conclusion: Pain index, BMI, Cambridge classification and disease duration are the most important factors adversely affecting QoL in CP. Measurement of QoL is essential in the disease management and improves the knowledge of psychosocial functioning of these patients.