Chronic pancreatitis in 2011

Česká verzia

Authors: Petr Dítě ^{1, 2} ; J. Trna ²; I. Novotný ³; K. Floreanová ²; H. Nechutová ²; E. Geryk ⁴
Authors place of work: Lékařská fakulta Ostravské univerzity Ostrava, děkan doc. MUDr. Arnošt Martínek, CSc. ¹; Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Aleš Hep, CSc. ²; Gastroenterologické oddělení Masarykova onkologického ústavu Brno, vedoucí oddělení MUDr. Milana Šachtová, CSc. et Ph. D. ³; Fakultní nemocnice Brno, ředitel MUDr. Roman Kraus, MBA ⁴
Published in the journal: Vnitř Lék 2011; 57(11): 891-896
Category: Birthday

Summary

The incidence of chronic pancreatitis grows slowly but steadily. At present, alcohol is the most frequent risk factor, although the new forms of so called non-alcoholic chronic pancreatitis, such as genetically induced pancreatitis and its autoimmune variety, are carefully watched. Alcohol consumption continues to be most closely associated with the disease, though it is no more than a risk factor and other aspects, e.g. genetic predisposition, are prerequisite to the disease development. Imaging methods play a fundamental role in diagnosing the disease; non-invasive magnetic resonance and CT, invasive but safe endosonography, and diagnostically rarely used ECRP that, because of its invasive nature, is currently predominantly used for therapeutic purposes. Genetic markers are also exploited, including CFTR mutation, SPINK 1 and PRRS 1 gene, immunoglobulin G4 in the autoimmune form of the disease as well as, alternatively, pancreatic biopsy. Disease symptoms, i.e. pancreatic malabsorption (enzymes with high lipase content) and pancreatic pain are treated conservatively, with paracetamol as the first line therapy for pain followed, if necessary, by so called synaptic analgesics. Alternatively, endoscopic techniques (drainage) or surgery (drainage and resection) are applied. Hereditary and non-hereditary chronic pancreatitis is among the risk factors for pancreatic cancer and thus patients with these diseases should be closely followed up.

Key words:
chronic pancreatitis – TIGARO classification – hereditary pancreatitis – autoimmune pancreatitis – pancreatic enzymes

Zdroje

1. Spanier BWM, Dijkgraaf MGW, Bruno MJ. Epidemiology, etiology and outcome of acute and chronic pancreatitis: An update. Best Pract Res Clin Gastroenterol 2008; 22: 45–68.

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

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

4. Ammann RW, Hertz PU, Klöppel G. Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology 1996; 111: 224–231.

5. Tolstrup JS, Kristiansen L, Becker U. Smoking and risk of acute and chronic pancreatitis among women and men: a population-based cohort study. Arch Intern Med 2009; 169: 603–609.

6. Witt H, Apte MV, Keim V et al. Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology 2007; 132: 1557–1573.

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

8. 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.

9. Davila JA, El-Serag HB. GI epidemiology: databases for epidemiological studies. Aliment Pharmacol Ther 2007; 25: 169–176.

10. Witt H, Luck W, Hennies HC et al. Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis. Nat Genet 2000; 25: 213–216.

11. Kamisawa T, Anjiki H, Takuma K et al. The natural course of autoimmune pancreatitis. Hepatogastroenterology 2009; 56: 866–870.

12. Buscarini E, Frulloni L, De Lisi S et al. Autoimmune pancreatitis: a challenging diagnostic puzzle for clinicians. Dig Liver Dis 2010; 42: 92–98.

13. Lankisch PG, Schmidt I, König 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.

14. Domínguez-Muñoz JE, Iglesias-García J, Vilariño-Insua M et al. 13C-mixed triglyceride breath test to assess oral enzyme substitution therapy in patients with chronic pancreatitis. Clin Gastroenterol Hepatol 2007; 5: 484–488.

15. Graziani R, Tapparelli M, Malagò R et al. The various imaging aspects of chronic pancreatitis. JOP 2005; 6: 73–88.

16. Shams J, Stein A, Cooperman AM. Computed tomography for pancreatic diseases. Surg Clin North Am 2001; 81: 283–236.

17. Wallace MB, Hawes RH. Endoscopic ultrasound in the evaluation and treatment of chronic pancreatitis. Pancreas 2001; 23: 26–35.

18. Catalano MF. Diagnosing early-stage chronic pancreatitis: is endoscopic ultrasound a reliable modality? J Gastroenterol 2007; 42 (Suppl 17): 78–84.

19. Sugiyama M, Haradome H, Atomi Y. Magnetic resonance imaging for diagnosing chronic pancreatitis. J Gastroenterol 2007; 42 (Supp 17): 108–112.

20. Czakó L. Diagnosis of early-stage chronic pancreatitis by secretin-enhanced magnetic resonance cholangiopancreatography. J Gastroenterol 2007; 42 (Suppl 17): 113–117.

21. Caliari S, Benini L, Sembenini C et al. Medium-chain triglyceride absorption in patients with pancreatic insufficiency. Scand J Gastroenterol 1996; 31: 90–94.

22. Meier R, Ockenga J, Pertkiewicz M et al. ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition: Pancreas. Clin Nutr 2006; 25: 275–284.

23. Dominguez- Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep 2007; 9: 116–122.

24. Layer P, Keller J, Lankisch PG. Pancreatic enzyme replacement therapy. Curr Gastroenterol Rep 2001; 3: 101–108.

25. Delhaye M, Arvanitakis M, Verset G et al. Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis. Clin Gastroenterol Hepatol 2004; 2: 1096–1106.

26. Delhaye M, Arvanitakis M, Bali M et al. Endoscopic therapy for chronic pancreatitis. Scand J Surg 2005; 94: 143–153.

27. Devière J, Bell RH Jr, Beger HG et al. Treatment of chronic pancreatitis with endotherapy or surgery: critical review of randomized control trials. J Gastrointest Surg 2008; 12: 640–644.

28. Tringali A, Boskoski I, Costamagna G. The role of endoscopy in the therapy of chronic pancreatitis. Best Pract Res Clin Gastroenterol 2008; 22: 145–165.

29. 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.

30. 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.

31. Kamisawa T, Tu Y, Egawa N et al. The incidence of pancreatic and extrapancreatic cancers in Japanese patients with chronic pancreatitis. Hepatogastroenterology 2007; 54: 1579–1581.

32. Bansal P, Sonnenberg A. Pancreatitis is a risk factor for pancreatic cancer. Gastroenterology 1995; 109: 247–251.

33. Lowenfels AB, Maisonneuve P, Cavallini G et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 1993; 328: 1433–1437.