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 24 November 2017

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News

Pain relief in chronic pancreatitis with or without surgery, cancer risk, and mortality

Long-term pain relief is similar in patients with alcoholic and nonalcoholic pancreatitis, finds a research team in the latest issue of the Journal of Clinical Gastroenterology.

News image

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The research team from Baltimore, Maryland, sought to determine the natural history of chronic pancreatitis (CP).

They retrospectively studied 193 consecutive patients, who had at least 1 hospitalization for the control of pain or a complication of CP.

Patients were assessed using hospital records and a standard questionnaire.

The researchers found that alcohol (66%) was the major cause of CP, and that the cause was unknown in 21%.

The team found pain to be the presenting symptom in 93% of cases.

Mortality in chronic pancreatitis:
  • alcoholic = 35%
  • nonalcoholic = 10%
Journal of Clinical Gastroenterology

They observed pancreatic calcification in 41% (alcoholic 54% versus nonalcoholic 19%).

The team determined diabetes (28%), malabsorption (16%), pseudocysts (21%) and pancreatic (3%) or extrapancreatic malignancy (5%) to be the main complications.

They also found that 43% had surgical intervention for pain relief, 10% had either endoscopic sphincterotomy or surgical sphincteroplasty, and 16% had surgery for complications.

However, surgical or endoscopic intervention was more commonly performed in nonalcoholics, compared with alcoholics.

If sphincterotomy and sphincteroplasty were excluded, the total number of surgical procedures for pain relief was similar in both groups.

Complete follow-up information was available in 107 patients, with a mean duration of follow-up of 10 years. The team found that 27 patients died during the follow-up, with 5, 10 and 15 year mortality being 14%, 18% and 20%, respectively.

Mortality was significantly higher in patients with alcoholic CP than in nonalcoholic CP (35% versus 10%).

Of the remaining 80 patients with complete follow-up, pain improved in 62, remained unchanged in 17, and worsened in 1.

In addition, pain improved in 83% of patients who had surgical intervention for pain, 78% who had surgery for complications, 57% who had sphincter ablation, and 74% who had nonprocedural treatment.

Dr Paul Thuluvath ’s team concluded, “Long-term pain relief was similar in patients with alcoholic and nonalcoholic pancreatitis”.

J Clin Gastroenterol 2003; 36(2): 159-65
21 January 2003

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