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Non-pharmacological pain palliation methods in chronic pancreatitis

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World Journal of Clinical Cases 2023年第35期11卷 8263-8269页

作者： Mesut Tez EdaŞahingöz Hüseyin Fahri Martlı Department of Surgery University of Health SciencesAnkara City HospitalAnkara 06800Turkey Department of General Surgery Sağlık Bilimleri UniversityAnkara 06100Turkey Department of General Surgery Ankara Atatürk Sanatoryum Training and Research HospitalAnkara 06100Turkey

chronic pancreatitis(CP)is a condition characterized by persistent and often severe pain resulting from the inflammatory disease of the pancreas.While pharmacological treatments play a significant role in palliative pain management,some patients require non-pharmacological methods.This review article focuses on non-pharmacological approaches used to alleviate pain in CP.The article examines non-pharmacological palliation options,including surgery,endoscopic approaches,neurostimulation techniques,acupuncture,and other alternative medicine methods.The effectiveness of each method is evaluated,taking into consideration patient compliance and side effects.Additionally,this article emphasizes the importance of personalized pain management in CP and underscores the need for a multidisciplinary approach.It aims to summarize the existing knowledge on the use of non-pharmacological palliation methods to improve the quality of life for patients with CP.

关键词： chronic pancreatitis Pain Surgery Endoscopy

Coexistent alcohol-related cirrhosis and chronic pancreatitis have a comparable phenotype to either disease alone:A comparative retrospective analysis

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World Journal of Hepatology 2023年第3期15卷 431-440页

作者： Michael Lu Yujie Sun Robert Feldman Melissa Saul Andrew Althouse Gavin Arteel Dhiraj Yadav Department of Medicine University of Pittsburgh Medical CenterPittsburghPA 15213United States Department of Medicine Center for Research on Health Care DataPittsburghPA 15213United States Division of Gastroenterology Hepatologyand NutritionUniversity of Pittsburgh Medical CenterPittsburghPA 15213United States Department of Medicine Division of GastroenterologyHepatology and NutritionUniversity of Pittsburgh Medical CenterPittsburghPA 15213United States

BACKGROUND Alcohol use disorder is a prevalent disease in the United States.It is a well-demonstrated cause of recurrent and long-standing liver and pancreatic injury which can lead to alcohol-related liver cirrhosis(ALC)and chronic pancreatitis(ACP).ALC and ACP are associated with significant healthcare utilization,cost burden,and mortality.The prevalence of coexistent disease(CD)ranges widely in the literature and the intersection between ALC and ACP is inconsistently charac-terized.As such,the clinical profile of coexistent ALC and ACP remains poorly understood.We hypothesized that patients with CD have a worse phenotype when compared to single organ disease.AIM To compare the clinical profile and outcomes of patients with CD from those with ALC or ACP Only.METHODS In this retrospective comparative analysis,we reviewed international classi-fication of disease 9/10 codes and electronic health records of adult patients with verified ALC Only(n=135),ACP Only(n=87),and CD(n=133)who received care at UPMC Presbyterian-Shadyside Hospital.ALC was defined by histology,imaging or clinical evidence of cirrhosis or hepatic decompensation.ACP was defined by imaging findings of pancreatic calcifications,moderate-severe pancreatic duct dilatation,irregularity or atrophy.We compared demographics,pertinent clinical variables,healthcare utilization,and mortality for patients with CD with those who had single organ disease.RESULTS Compared to CD or ACP Only,patients with ALC Only were more likely to be older,Caucasian,have higher body mass index,and Hepatitis B or C infection.CD patients(vs ALC Only)were less likely to have imaging evidence of cirrhosis and portal hypertension despite possessing similar MELD-Na and Child C scores at the most recent contact.CD patients(vs ACP Only)were less likely to have acute or recurrent acute pancreatitis,diabetes mellitus,insulin use,oral pancreatic enzyme therapy,and need for endoscopic therapy or pancreatic surgery.The number of hospitalizations in patients with CD were similar to ACP Only

关键词： Alcohol Cirrhosis chronic pancreatitis Overlap Phenotype

Vascular complications of chronic pancreatitis and its management

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1574-1590页

作者： Dinesh Walia Anoop Saraya Deepak Gunjan Gastroenterology and Human Nutrition Unit All India Institute of Medical SciencesNew Delhi 110029India

chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas,resulting in recurrent abdominal pain,diabetes mellitus,and malnutrition.It may lead to various other complications such as pseudocyst formation,benign biliary stricture,gastric outlet obstruction;and vascular complications like venous thrombosis,variceal and pseudoaneurysmal bleed.Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy.Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration,or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations.Procedure-related bleed is usually venous and mostly managed conservatively.Procedure-related arterial bleed,however,may require radiological interventions.

关键词： chronic pancreatitis Pseudoaneurysm Vascular complications Varices Venous thrombosis

chronic pancreatitis, pancreatic adenocarcinoma and the black box in-between

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Cell Research 2005年第1期15卷 72-77页

作者： Natalia JURA Herbert ARCHER Dafna BAR-SAGI Department of Molecular Genetics and Microbiology Stony Brook University NY 11794-5222 USA.Graduate Program in Molecular and Cellular Biology USA.

Pancreatic cancer is a challenging disease for patients, doctors and researchers who for decades have searched for a cure for this deadly malignancy. Although existing mouse models of pancreatic cancer have shed light on the mecha- nistic basis of the neoplastic conversion of the pancreas, their impact in terms of offering new diagnostics and therapeu- tic modalities remains limited. chronic pancreatitis is an inflammatory disease of the pancreas that is associated with a gradual damage of the organ and an increased risk of developing neoplastic lesions. In this review, we propose that detailed studies of chronic inflammatory processes in the pancreas will provide insights into the evolution of pancreatic cancer. This information may prove useful in the design of effective therapeutic strategies to battle the disease.

关键词： pancreatic cancer chronic pancreatitis hereditary pancreatitis inflammation mouse models.

Epidemiologic risk factors for patients admitted with chronic pancreatitis and pancreatic ductal adenocarcinoma in the United States

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World Journal of Clinical Oncology 2022年第11期13卷 907-917页

作者： Daniel Lew Fatima Kamal Khiem Phan Karamvir Randhawa Sam Cornwell Ayrton I Bangolo Simcha Weissman Stephen J Pandol Department of Gastroenterology Cedars-Sinai Medical CenterLos AngelesCA 90048United States Department of Internal Medicine Hackensack Meridian Health/Palisades Medical CenterNorth BergenNJ 07047United States

BACKGROUND Epidemiological studies of chronic pancreatitis(CP)and its association with pancreatic ductal adenocarcinoma(PDAC)are limited.Understanding demographic and ethno-racial factors may help identify patients at the highest risk for CP and PDAC.AIM To evaluate the ethno-racial risk factors for CP and its association with PDAC.The secondary aim was to evaluate hospitalization outcomes in patients admitted with CP and PDAC.METHODS This retrospective cohort study used the 2016 and 2017 National Inpatient Sample databases.Patients included in the study had ICD-10 codes for CP and PDAC.The ethnic,socioeconomic,and racial backgrounds of patients with CP and PDAC were analyzed.RESULTS Hospital admissions for CP was 29 per 100000,and 2890(0.78%)had PDAC.Blacks[adjusted odds ratio(aOR)1.13],men(aOR 1.35),age 40 to 59(aOR 2.60),and being overweight(aOR 1.34)were significantly associated with CP(all with P<0.01).In patients with CP,Whites(aOR 1.23),higher income,older age(aOR 1.05),and being overweight(aOR 2.40)were all significantly associated with PDAC(all with P<0.01).Men(aOR 1.81)and Asians(aOR 15.19)had significantly increased mortality(P<0.05).Hispanics had significantly increased hospital length of stay(aOR 5.24)(P<0.05).CONCLUSION Based on this large,nationwide analysis,black men between 40-59 years old and overweight are at significantly increased risk for admission with CP.White men older than 40 years old and overweight with higher income were found to have significant associations with CP and PDAC.This discrepancy may reflect underlying differences in healthcare access and utilization among different socioeconomic and ethno-racial groups.

关键词： chronic pancreatitis Pancreatic cancer Ethno-racial Risk factors Hospitalization outcomes Adult

Long-term outcome of patients with chronic pancreatitis treated with micronutrient antioxidant therapy

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Hepatobiliary & Pancreatic Diseases International 2017年第2期16卷 209-214页

作者： Sukitha Namal Rupasinghe Ajith K Siriwardena Hepatobiliary Surgery Unit Manchester Royal Infirmary Oxford Road Manchester M13 9WL UK

BACKGROUND： Micronutrient antioxidant therapy did not relieve pain in a European randomized trial of patients with chronic pancreatitis without malnutrition. However, intervention was undertaken only for 6 months leaving unanswered the question of whether long-term antioxidant therapy may modulate chronic pancreatitis. The aim of this study is to assess the outcome of long-term use of micronutrient antioxidant therapy in patients with chronic pancreatitis.METHODS： This is a single center clinical cohort report of patients with chronic pancreatitis prescribed micronutrient antioxidant therapy and followed for up to 10 years. Data were collected on demographic detail, clinic pain assessment, insulin requirements, interventions and outcome.RESULTS： A group of 30 patients with a diagnosis of chronic pancreatitis constitute the study population. Median age at time of diagnosis was 40 years（range 14-66）; 19（63%） were male and the median duration of symptoms was 2 years（range 0-18）. Alcohol was the dominant cause in 22（73%） patients and 16（53%） patients were Cambridge stage 1. Twenty-four（80%） patients had pain at presentation. During antioxidant treatment of 4 years（range 1-10）, pain decreased but the proportion with abdominal pain compared to those who were pain-free remained constant（P=0.16; two-way ANOVA with Bonferroni correction）. There was a significant increase in requirement for insulin（P=0.028） with time together with use of both endoscopic and surgical interventions.CONCLUSIONS： This is the first study to report long-term disease-specific outcome in patients with chronic pancreatitis prescribed micronutrient antioxidant therapy. There appears to be no effect of intervention on outcome.

关键词： chronic pancreatitis antioxidant therapy micronutrient Antox outcomes

A meta-analysis of the long-term effects of chronic pancreatitis surgical treatments： duodenum-preserving pancreatic head resection versus pancreatoduodenectomy

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Chinese Medical Journal 2013年第1期126卷 147-153页

作者： LU Wen-ping SHI Qing ZHANG Wen-zhi CAI Shou-wang JIANG Kai DONG Jia-hong Department of Hepatobiliary Surgery Chinese People's LiberationArmy General Hospital Beijing 100853 China Department of Microbiology Peking University Health ScienceCenter Beijing 100191 China

Background Surgery is regarded as the most effective treatment to relieve pain and reduce complications in chronic pancreatitis （CP）. Two major strategies exist： duodenum-preserving pancreatic head resection （DPPHR） and pancreatoduodenectomy （PD）. Many studies suggest that DPPHR offers advantages during surgery and in the short-term; however, the long-term effects have not been thoroughly investigated. We analyzed the long-term outcomes of DPPHR and PD, over follow-up times of at least 1 year, to determine the optimal surgical treatment for CP. Methods We systemically reviewed all CP surgical treatment reports, and only included randomized controlled trials （RCT） comparing DPPHR and PD, excluding unqualified studies using several pre-specified criteria. When multiple publications of a single trial were found, the most comprehensive current data were selected. Characteristics of the study populations and long-term postoperative outcome parameters were collected. The quality of the studies and data was analyzed using RevMan 4.2 software. Results Five trials were qualified for meta-analysis, with 261 participants in total （114 in the DPPHR group and 147 in the PD group）. There were no significant differences in the age, gender, or indications for surgery of each group. At the mean of 5.7-year （1-14 years） follow-up examination, DPPHR and PD resulted in equally effective pain relief, exocrine and endocrine function, and similar mortality rates （P 〉0.05）; however, DPPHR patients had improved global quality of life and weight gain, and reduced diarrhea and fatigue （P 〈0.05）. Conclusion DPPHR and PD result in equal pain relief, mortality, and pancreatic function; however, DPPHR provides superior long-term outcomes.

关键词： chronic pancreatitis surgical treatments long-term postoperative effect meta-analysis

Decreased serum essential and aromatic amino acids in patients with chronic pancreatitis

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World Journal of Gastroenterology 2010年第35期16卷 4422-4427页

作者： Krystian Adrych Marian Smoczynski Magdalena Stojek Tomasz Sledzinski Ewa Slominska Elzbieta Goyke Ryszard Tomasz Smolenski Julian Swierczynski Department of Gastroenterology and Hepatology Medical University of Gdansk Department of Pharmaceutical Biochemistry Medical University of Gdansk Department of Biochemistry Medical University of Gdansk

AIM:To investigate the influence of chronic pancreatitis(CP) on serum concentrations of amino acids.METHODS:Thirty-five male patients with alcoholic CP and 21 healthy male subjects were examined.Serum concentrations of amino acids were assayed by ionpair high-performance liquid chromatography with mass detection.RESULTS:Serum glutamate concentration was increased in CP patients as compared to controls.In contrast,serum concentrations of glutamine,histidine,tyrosine,proline,tryptophan and threonine were significantly decreased in CP patients.A trend towards decreasing concentrations of serum lysine,alanine,methionine and valine as well as for total serum amino acids was observed.The sum of aromatic and the sum of essential amino acid concentrations were significantly lower in CP patients than in controls.CONCLUSION:CP leads to decreased serum concentrations of several amino acids,such as essential and aromatic serum amino acids,most likely due to decreased exocrine function.

关键词： Amino acids Body mass index chronic pancreatitis Maldigestion Malnutrition

Reporting of longitudinal pancreatojejunostomy with partial pancreatic head resection(the Frey procedure) for chronic pancreatitis: A systematic review

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Hepatobiliary & Pancreatic Diseases International 2021年第2期20卷 110-116页

作者： Minas Baltatzis Santhalingam Jegatheeswaran Ajith K Siriwardena Regional Hepato-Pancreato-Biliary Surgery Unit Manchester Royal InfirmaryOxford RoadManchester M139WLUK Faculty of Biology Medicine and HealthUniversity of ManchesterManchesterUK

Background:Longitudinal pancreatojejunostomy with partial pancreatic head resection(the Frey procedure)is accepted for surgical treatment of painful chronic pancreatitis.However,conduct and reporting are not standardized and thus,making comparisons difficult.This study assesses the reporting standards of this procedure.Data sources:A systematic literature review was performed between January 1987 and January 2020.The keyword and Medical Subject Heading"chronic pancreatitis"was used together with the individual operation term"Frey pancreatojejunostomy".Reports were included if they provided original information on conduct and outcome.Thirty-three papers providing information on 1205 patients constituted the study population.Risk of bias in included reports was assessed.Results:Etiology of chronic pancreatitis(alcohol)was reported in 26 of 28(93%)studies,duration of symptoms prior to surgery in 19(58%)studies and pre-operative opiate use in 12(36%)studies.In terms of morphology,pancreatic duct diameter was reported in 17(52%)studies and diameter of the pancreatic head in 13(39%)studies.In terms of technique,three(9%)studies reported weight of excised parenchyma.There were 9(0.7%)procedure-related deaths.Post-operative follow-up ranged from 6 to 82.5 months.No studies reported post-operative portal hypertension.Conclusions:There is substantial heterogeneity between studies in reporting of clinical baseline,morphology of the diseased pancreas,operative detail and outcome after longitudinal pancreatojejunostomy with partial pancreatic head resection.This critically compromises the comparison between centers and between surgeons.Structured reporting is necessary for clinicians to assess choice of procedure and for patients to make informed choices when seeking treatment for painful chronic pancreatitis.

关键词： chronic pancreatitis Frey procedure Reporting Longitudinal pancreatojejunostomy