Natural Course in Chronic Pancreatitis

Lankisch, P. G.; Löhr-Happe, Annette; Otto, J.; Creutzfeldt, W.

doi:10.1159/000201029

Cited by 389 publications

(49 citation statements)

References 10 publications

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“…Moreover, the cumulative risk of pancreatic cancer increased distinctly, and 10 and 20 years after a diagnosis of CP, the risks were found to be 1.8 and 4%, respectively, in a multicenter study conducted by Lowenfels et al[ 24]. The incidence of associated pancreatic cancer was found to be 1.6% in a recent Japanese study[ 28], and the overall incidence of pancreatic cancer in our study was 3.1%, which is similar to several Western studies that reported a higher incidence of pancreatic cancer in CP [20, 26, 27]. Smoking is the most well-established risk factor of pancreatic cancer, and this risk appears to be independent of sex, country, or type of pancreatitis[ 25].…”

Section: Discussionsupporting

confidence: 89%

“…The incidence of pancreatic cancer during the course of CP has been reported to range from 1.1 to 3% in the West[ 20,22,23,24,25,26,27]. Moreover, the cumulative risk of pancreatic cancer increased distinctly, and 10 and 20 years after a diagnosis of CP, the risks were found to be 1.8 and 4%, respectively, in a multicenter study conducted by Lowenfels et al[ 24].…”

Section: Discussionmentioning

confidence: 99%

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Clinical Features of Chronic Pancreatitis in Korea: A Multicenter Nationwide Study

Ryu¹,

Lee²,

Kim³

et al. 2005

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Background/Aims: No reliable nationwide clinical data about chronic pancreatitis (CP) was available in Korea. The etiology and clinical features of CP were investigated using a multicenter nationwide study. Methods: 814 cases of CP were enrolled retrospectively over the past 4 years at 13 hospitals. The following data were obtained from all patients: etiology, symptoms, complications, and surgery. Result: Alcohol (64.3%) was the major cause of CP and idiopathic CP (20.8%) was the second most common form. Mean patient age was 50.6 years and the male:female ratio was 6:1 (24:1 for alcoholic CP vs. 2:1 in idiopathic CP, p < 0.001). Diabetes (31.6%), pseudocysts (28.4%), biliary stricture (13.9%), and pancreatic ascites (6.6%) were the main complications. Of these, diabetes (35 vs. 26%) and pseudocyst (33.7 vs. 21.9%) were more frequent in alcoholic than in idiopathic CP. Pancreatic cancer developed in 25 patients (3.1%) during follow-up and their mean age was 59.1 years. Conclusions: In Korea, alcohol is the most common etiology of CP. Moreover, diabetes and pseudocysts are frequent complications, especially in alcoholic CP, and pancreatic cancer development is not infrequent.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Clinical Features of Chronic Pancreatitis in Korea: A Multicenter Nationwide Study

Ryu¹,

Lee²,

Kim³

et al. 2005

Digestion

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“…In contrast to chronic pancreatitis, where exocrine pancreatic insufficiency deteriorates within 6.5 years in more than 40% of the patients [24], exocrine pancreatic function, if initially normal or abnormal, does not change significantly in type-1 diabetes mellitus. If abnormal, exocrine pancreatic insufficiency is only mild to moderate and stays in this range.…”

Section: Discussionmentioning

confidence: 99%

Follow-Up of Exocrine Pancreatic Function in Type-1 Diabetes mellitus

et al. 2005

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In a previous study, mild to moderate exocrine pancreatic insufficiency, as measured by the secretin-pancreozymin test, was found in 23 (43%) of 53 patients with type-1 diabetes mellitus. Of these 53 patients, 20 (7 of whom initially had an abnormal secretin-pancreozymin test) were available for a follow-up examination 11 years later. Of the 7 patients with abnormal exocrine pancreatic function at the first test, 5 remained abnormal and 2 became normal, whereas of the 13 patients with initially normal pancreatic function the test result remained normal in 11 patients and became abnormal in 2. In these 2 groups the test result did not differ significantly between both tests. However, exocrine pancreatic function had returned to normal or had become abnormal in 2 patients, respectively, at the second test. In the 3 patients with exocrine pancreatic insufficiency at the first and second tests, the lipase level had not fallen below 10% or less than the normal level at which steatorrhea occurs and therapy is required. There was no significant correlation between the duration of the diabetes and the test results for both time points of investigation. The data suggest that mild to moderate exocrine pancreatic insufficiency found in type-1 diabetes is due to an early event in the course of the diabetes and does not progress. Therefore, this finding is of minor clinical importance and expensive pancreatic enzyme substitution will not be required.

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“…Lankisch et al [22]showed that in patients with chronic pancreatitis the survival rate 10 years after conservative treatment was 80% for non- alcoholics and 65% for patients still consuming alcoholic beverages. Lowenfels et al [23]described a 10-year survival rate of 70%, whereby continuous nicotine and alcohol consumption influenced the prognosis of the patients negatively.…”

Section: Discussionmentioning

confidence: 99%

Distal Pancreatectomy in Chronic Pancreatitis

et al. 1999

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Background: The indications for a resective procedure in chronic pancreatitis are severe pain and local complications. The aim of this study, based on prospectively assessed data, was to evaluate distal pancreatectomy in patients suffering from chronic pancreatitis localized in the corpus and cauda of the pancreatic gland. Methods: Seventy-four patients undergoing distal pancreatectomy were evaluated pre- and postoperatively (after a median observation period of 58 months) for pain, professional status, alcohol consumption, and endocrine function as measured by the glucose tolerance test preoperatively. Results: The indication for operation was severe therapy-resistant pain in nearly all patients and an inflammatory tumor or pancreatic pseudocysts in over 50% of the patients. One fourth of the patients were operated in order to exclude malignancy. Ninety-five percent of the patients underwent distal pancreatectomy, only in 4 cases (5%) was a subtotal (Child) resective procedure performed. In 34% of patients undergoing distal pancreatectomy a splenectomy could be avoided. The early postoperative complications were few and mostly due to the severe comorbidity of the patients. During the median observation period of 58 months 14.7% of the patients died due to diseases not related to distal pancreatectomy. Six percent of the patients could not be reevaluated and were lost to follow-up. In the remaining 59 patients 88% had significantly less pain and 66% had an increase in median body weight of 8 kg. Fifty percent of the patients had full or partial professional rehabilitation, one fourth was unemployed and 24% had retired due to age. 51.7% had a normal endocrine function as assessed by the glucose tolerance test, 16.2 and 21.6% had a latent or manifest diabetes mellitus, respectively. In 74.5% of all patients the endocrine function did not worsen during the observation period. Conclusion: In comparison to conservative treatment distal pancreatectomy is a suitable therapeutic measure in patients with severe pain and local complications. It significantly improves the quality of life of patients without compromising endocrine function. Postoperative lethality is lower than in conservatively treated patients and is not related to distal pancreatectomy.

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Natural Course in Chronic Pancreatitis

Cited by 389 publications

References 10 publications

Clinical Features of Chronic Pancreatitis in Korea: A Multicenter Nationwide Study

Clinical Features of Chronic Pancreatitis in Korea: A Multicenter Nationwide Study

Follow-Up of Exocrine Pancreatic Function in Type-1 Diabetes mellitus

Distal Pancreatectomy in Chronic Pancreatitis

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