Chronic pancreatitis

Česká verzia

Authors: T. Hucl; P. Mačinga
Authors place of work: Klinika hepatogastroenterologie, Institut klinické a experimentální medicíny, Praha
Published in the journal: Kardiol Rev Int Med 2014, 16(3): 244-251
Category: Internal Medicine

Summary

Chronic pancreatitis is a progressive inflammatory disease characterized by the replacement of the pancreatic gland by fibrous tissue, resulting in an impairment of exocrine and endocrine function. Under the local conditions, the disease can usually be attributed to chronic alcohol abuse in combination with genetic, metabolic and environmental factors. Pancreatic stellate cells play a key role in the complex pathogenesis of the disease by producing fibrous tissue in response to various stimuli. The main symptoms include pain, maldigestion and diabetes. The management of patients with chronic pancreatitis requires an accurate diagnosis, recognition of aetiology, evaluation of symptoms and complications and adequate therapy often utilizing a multidisciplinary team. The goals of treatment are pain control, replacement of the lost digestive function with pancreatic enzymes, insulin therapy in diabetes patients and treatment of complications (for example bile duct stricture, pseudocyst). In the treatment of pain, non‑narcotic analgesics, opioids or their combinations with antipsychotics are used; in the treatment of pancreatic exocrine insufficiency preparations of pancreatin are administered. Patients who do not respond to medical therapy are candidates for interventional treatment. Endoscopic therapy is less effective than surgical therapy; however it often remains the method of choice for its safety and for preserving the possibility of a later surgical procedure. Endoscopy can be used with the help of extracorporeal lithotripsy to treat pancreatic duct stones, but more often it is used to treat pancreatic and bile duct strictures or to treat pseudocysts. Symptomatic pseudocysts are routinely drained transluminally under endosonography guidance. Surgical therapy, either in the form of drainage or resection, is very effective, but has a significant risk of complications.

Keywords:
chronic pancreatitis – alcohol – smoking – pain – pancreatic exocrine insufficiency

Zdroje

1. Lin Y, Tamakoshi A, Matsuno S et al. Nationwide epidemiological survey of chronic pancreatitis in Japan. J Gastroenterol 2000; 35: 136– 141.

2. Tinto A, Lloyd DA, Kang JY et al. Acute and chronic pancreatitis – diseases on the rise: a study of hospital admissions in England 1989/ 90– 1999/ 2000. Aliment Pharmacol Ther 2002; 16: 2097– 2105.

3. Dite P, Stary K, Novotny I et al. Incidence of chronic pancreatitis in the Czech Republic. Eur J Gastroenterol Hepatol 2001; 13: 749– 750.

4. Mačinga P, Špičák J, Hucl T. Etiopatogeneze chronické pankreatitidy. Gastroent Hepatol 2013; 67: 275– 288.

5. Lerch MM, Gorelick FS. Early trypsinogen activation in acute pancreatitis. Med Clin North Am 2000; 84: 549– 563.

6. Beer S, Zhou J, Szabo A et al. Comprehensive functional analysis of chymotrypsin C (CTRC) variants reveals distinct loss‑ of‑ function mechanisms associated with pancreatitis risk. Gut 2013; 62: 1616– 1624. doi: 10.1136/ gutjnl‑ 2012‑ 303090.

7. Szmola R, Sahin‑Toth M. Chymotrypsin C (caldecrin) promotes degradation of human cationic trypsin: identity with Rinderknecht's enzyme Y. Proc Natl Acad Sci U S A 2007; 104: 11227– 11232.

8. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 2001; 120: 682– 707.

9. Apte MV, Wilson JS, McCaughan GW et al. Ethanol‑induced alterations in messenger RNA levels correlate with glandular content of pancreatic enzymes. J Lab Clin Med 1995; 125: 634– 640.

10. Corrao G, Bagnardi V, Zambon A et al. Exploring the dose‑response relationship between alcohol consumption and the risk of several alcohol‑related conditions: a meta‑analysis. Addiction 1999; 94: 1551– 1573.

11. Kristiansen L, Gronbaek M, Becker U et al. Risk of pancreatitis according to alcohol drinking habits: a population‑based cohort study. Am J Epidemiol 2008; 168: 932– 937. doi: 10.1093/ aje/ kwn222.

12. Lankisch PG, Lowenfels AB, Maisonneuve P. What is the risk of alcoholic pancreatitis in heavy drinkers? Pancreas 2002; 25: 411– 412.

13. Yadav D, Eigenbrodt ML, Briggs MJ et al. Pancreatitis: prevalence and risk factors among male veterans in a detoxification program. Pancreas 2007; 34: 390– 398.

14. Spicak J, Pulkertova A, Kralova‑ Lesna I et al. Alcoholic chronic pancreatitis and liver cirrhosis: coincidence and differences in lifestyle. Pancreatology 2012; 12: 311– 316. doi: 10.1016/ j.pan.2012.05.008.

15. Witt H, Luck W, Becker M et al. Mutation in the SPINK1 trypsin inhibitor gene, alcohol use, and chronic pancreatitis. JAMA 2001; 285: 2716– 2717.

16. Talamini G, Bassi C, Falconi M et al. Cigarette smoking: an independent risk factor in alcoholic pancreatitis. Pancreas 1996; 12: 131– 137.

17. Chowdhury P, Bone RC, Louria DB et al. Effect of cigarette smoke on human serum trypsin inhibitory capacity and antitrypsin concentration. Am Rev Respir Dis 1982; 126: 177– 179.

18. Cavallini G, Talamini G, Vaona B et al. Effect of alcohol and smoking on pancreatic lithogenesis in the course of chronic pancreatitis. Pancreas 1994; 9: 42– 46.

19. Lindkvist B, Appelros S, Manjer J et al. A prospective cohort study of smoking in acute pancreatitis. Pancreatology 2008; 8: 63– 70. doi: 10.1159/ 000114868.

20. Tolstrup JS, Kristiansen L, Becker U et al. Smoking and risk of acute and chronic pancreatitis among women and men: a population‑based cohort study. Arch Intern Med 2009; 169: 603– 609. doi: 10.1001/ archinternmed.2008.601.

21. Stevens T, Conwell DL, Zuccaro G. Pathogenesis of chronic pancreatitis: an evidence‑based review of past theories and recent developments. Am J Gastroenterol 2004; 99: 2256– 2270.

22. Howes N, Lerch MM, Greenhalf W et al. Clinical and genetic characteristics of hereditary pancreatitis in Europe. Clin Gastroenterol Hepatol 2004; 2: 252– 261.

23. Lowenfels AB, Maisonneuve P, DiMagno EP et al. Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group. J Natl Cancer Inst 1997; 89: 442– 446.

24. Malka D, Hammel P, Maire F et al. Risk of pancreatic adenocarcinoma in chronic pancreatitis. Gut 2002; 51: 849– 852.

25. Yadav D, Timmons L, Benson JT et al. Incidence, prevalence, and survival of chronic pancreatitis: a population‑based study. Am J Gastroenterol 2011; 106: 2192– 2199. doi: 10.1038/ ajg.2011.328.

26. Threadgold J, Greenhalf W, Ellis I et al. The N34S mutation of SPINK1 (PSTI) is associated with a familial pattern of idiopathic chronic pancreatitis but does not cause the disease. Gut 2002; 50: 675– 681.

27. Cohn JA, Friedman KJ, Noone PG et al. Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis. N Engl J Med 1998; 339: 653– 658.

28. Sharer N, Schwarz M, Malone G et al. Mutations of the cystic fibrosis gene in patients with chronic pancreatitis. N Engl J Med 1998; 339: 645– 652.

29. Bombieri C, Claustres M, De Boeck K et al. Recommendations for the classification of diseases as CFTR‑related disorders. J Cyst Fibros 2011; 10 (Suppl 2): S86– S102. doi: 10.1016/ S1569‑ 1993(11)60014‑ 3.

30. Chen JM, Ferec C. Genetics and pathogenesis of chronic pancreatitis: the 2012 update. Clin Res Hepatol Gastroenterol 2012; 36: 334– 340. doi: 10.1016/ j.clinre.2012.05.003.

31. LaRusch J, Whitcomb DC. Genetics of pancreatitis. Curr Opin Gastroenterol 2011; 27: 467– 474. doi: 10.1097/ MOG.0b013e328349e2f8.

32. Chen JM, Ferec C. Chronic pancreatitis: genetics and pathogenesis. Annu Rev Genomics Hum Genet 2009; 10: 63– 87. doi: 10.1146/ annurev‑ genom‑ 082908‑ 150009.

33. Ammann RW, Akovbiantz A, Largiader F et al. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical‑ surgical series of 245 patients. Gastroenterology 1984; 86: 820– 828.

34. Dutta SK, Bustin MP, Russell RM et al. Deficiency of fat‑ soluble vitamins in treated patients with pancreatic insufficiency. Ann Intern Med 1982; 97: 549– 552.

35. Duggan SN, Smyth ND, Murphy A et al. High prevalence of osteoporosis in patients with chronic pancreatitis: a systematic review and meta‑analysis. Clin Gastroenterol Hepatol 2014; 12: 219– 228. doi: 10.1016/ j.cgh.2013.06.016.

36. Montalto G, Soresi M, Carroccio A et al. Lipoproteins and chronic pancreatitis. Pancreas 1994; 9: 137– 138.

37. Gullo L, Tassoni U, Mazzoni G et al. Increased prevalence of aortic calcification in chronic pancreatitis. Am J Gastroenterol 1996; 91: 759– 761.

38. Shimosegawa T, Chari ST, Frulloni L et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 2011; 40: 352– 358. doi: 10.1097/ MPA.0b013e3182142fd2.

39. Lankisch PG, Schmidt I, Konig H et al. Faecal elastase 1: not helpful in diagnosing chronic pancreatitis associated with mild to moderate exocrine pancreatic insufficiency. Gut 1998; 42: 551– 554.

40. Iglesias‑ García J, Vilariño M, Iglesias‑ Rey M et al. Accuracy of the optimized 13C‑ Mixed Triglyceride Breath test for the diagnosis of steatorrhea clinical practice. Gastroenterology 2003; 124 (Suppl 1): A631.

41. Lieb JG 2nd, Forsmark CE. Review article: pain and chronic pancreatitis. Aliment Pharmacol Ther 2009; 29: 706– 719. doi: 10.1111/ j.1365‑ 2036.2009.03931.x.

42. Chauhan S, Forsmark CE. Pain management in chronic pancreatitis: A treatment algorithm. Best Pract Res Clin Gastroenterol 2010; 24: 323– 335. doi: 10.1016/ j.bpg.2010.03.007.

43. Jadad AR, Browman GP. The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. JAMA 1995; 274: 1870– 1873.

44. Hoffmeister A, Mayerle J, Beglinger C et al. S3– Consensus guidelines on definition, etiology, diagnosis and medical, endoscopic and surgical management of chronic pancreatitis German Society of Digestive and Metabolic Diseases (DGVS). Z Gastroenterol 2012; 50: 1176– 1224. doi: 10.1055/ s‑ 0032‑ 1325479.

45. Dominguez‑ Munoz JE, Iglesias‑ Garcia J, Iglesias‑ Rey M et al. Effect of the administration schedule on the therapeutic efficacy of oral pancreatic enzyme supplements in patients with exocrine pancreatic insufficiency: a randomized, three‑ way crossover study. Aliment Pharmacol Ther 2005; 21: 993– 1000.

46. Lohr JM, Oliver MR, Frulloni L. Synopsis of recent guidelines on pancreatic exocrine insufficiency. United Eur Gastroenterol J 2013. doi: 10.1177/ 2050640613476500.

47. Dumonceau JM, Delhaye M, Tringali A et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2012; 44: 784– 800. doi: 10.1055/ s‑ 0032‑ 1309840.

48. Dite P, Ruzicka M, Zboril V et al. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 2003; 35: 553– 558.

49. Cahen DL, Gouma DJ, Nio Y et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007; 356: 676– 684.

50. Dumonceau JM, Costamagna G, Tringali A et al. Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial. Gut 2007; 56: 545– 552.

51. Tandan M, Reddy DN, Santosh D et al. Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi‑ a large single center experience. Indian J Gastroenterol 2010; 29: 143– 148. doi: 10.1007/ s12664‑ 010‑ 0035‑ y.

52. Vitale GC, Cothron K, Vitale EA et al. Role of pancreatic duct stenting in the treatment of chronic pancreatitis. Surg Endosc 2004; 18: 1431– 1434.

53. Weber A, Schneider J, Neu B et al. Endoscopic stent therapy for patients with chronic pancreatitis: results from a prospective follow‑up study. Pancreas 2007; 34: 287– 294.

54. Francois E, Kahaleh M, Giovannini M et al. EUS‑ guided pancreaticogastrostomy. Gastrointest Endosc 2002; 56: 128– 133.

55. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993; 128: 586– 590.

56. Andren‑ Sandberg A, Dervenis C. Pancreatic pseudocysts in the 21st century. Part I: classification, pathophysiology, anatomic considerations and treatment. JOP 2004; 5: 8– 24.

57. Varadarajulu S, Lopes TL, Wilcox CM et al. EUS versus surgical cyst‑ gastrostomy for management of pancreatic pseudocysts. Gastrointest Endosc 2008; 68: 649– 655. doi: 10.1016/ j.gie.2008.02.057.

58. Rosso E, Alexakis N, Ghaneh P et al. Pancreatic pseudocyst in chronic pancreatitis: endoscopic and surgical treatment. Dig Surg 2003; 20: 397– 406.

59. Catalano MF, Linder JD, George S et al. Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis: comparison of single vs. multiple simultaneous stents. Gastrointest Endosc 2004; 60: 945– 952.

60. Hartel M, Tempia‑ Caliera AA, Wente MN et al. Evidence‑based surgery in chronic pancreatitis. Langenbecks Arch Surg 2003; 388: 132– 139.

61. Partington PF, Rochelle RE. Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 1960; 152: 1037– 1043.

62. Puestow CB, Gillesby WJ. Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg 1958; 76: 898– 907.

63. Arslanlar S, Jain R. Benign biliary strictures related to chronic pancreatitis: balloons, stents, or surgery. Curr Treat Options Gastroenterol 2007; 10: 369– 375.

64. Frulloni L, Falconi M, Gabbrielli A et al. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis 2010; 42 (Suppl 6): S381– S406. doi: 10.1016/ S1590‑ 8658(10)60682‑ 2.

65. Beger HG, Krautzberger W, Bittner R et al. Duodenum‑ preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery 1985; 97: 467– 473.

66. Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas 1987; 2: 701– 707.

67. Belina F, Fronek J, Ryska M. Duodenopancreatectomy versus duodenum‑ preserving pancreatic head excision for chronic pancreatitis. Pancreatology 2005; 5: 547– 552.

68. Izbicki JR, Bloechle C, Knoefel WT et al. Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas: a randomized study. Chirurg 1997; 68: 369– 377.