Natural Course of Chronic Pancreatitis

Lankisch, P. G.

doi:10.1159/000055786

Cited by 147 publications

(67 citation statements)

References 80 publications

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“…In type 2 diabetes, hyperglycaemia has been associated with a deficit in beta cell mass of ∼20-65% of normal [5][6][7][8][9][10][11], and studies in rodent models of autoimmune diabetes or in patients with newly onset type 1 diabetes indicate that the extent of beta cell loss amounts to ∼50-70% around the manifestation of type 1 diabetes [12][13][14]. Diabetes is also frequently found in patients with chronic pancreatitis (CP), secondary to the inflammatory process within the pancreas [15][16][17]. Previous studies have shown that beta cell mass is also significantly reduced in patients with CP, even though the islet destruction appears to occur relatively late during the clinical course of the disease [17].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown that beta cell mass is also significantly reduced in patients with CP, even though the islet destruction appears to occur relatively late during the clinical course of the disease [17]. However, conflicting data have been reported with regard to the prevalence of diabetes in patients with CP and its relationship to disease duration [15,16,18].…”

Section: Introductionmentioning

confidence: 99%

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Determinants of glucose control in patients with chronic pancreatitis

et al. 2010

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Aims/hypothesis Diabetes frequently develops in patients with chronic pancreatitis (CP). Partial pancreatectomy has emerged as a treatment option for such patients. We addressed whether the development of diabetes in CP patients is related to pancreatic beta cell area or clinical variables, and which factors predict the diabetes risk after partial pancreatectomy. Methods Fractional beta cell area was determined in pancreatic tissue samples obtained from 114 CP patients undergoing pancreatic surgery and related to measures of glucose control, as well as clinical and anthropometric data. Seventy-four patients without diabetes at the time of surgery were contacted again 2.5±1.0 years after partial pancreatectomy in order to obtain information about the post-operative development of diabetes. Results In the surgical samples in the whole cohort, pancreatic beta cell area was 0.40±0.06% in patients with and 0.64±0.06% in those without previously known diabetes (p=0.039). There was an inverse non-linear relationship between pancreatic beta cell area and fasting glucose concentrations (r=0.29) as well as HbA 1c levels (r=0.36). Nineteen out of 74 previously normoglycaemic patients (26%) developed diabetes over an average period of 2.5 years of follow-up. Pre-operative fasting glucose levels, HbA 1c and BMI were identified as predictors of diabetes after partial pancreatectomy. However, pancreatic beta cell area did not differ in those who subsequently developed diabetes (0.66±0.15%) and those who did not (0.62± 0.08%, p=0.45). Conclusions/interpretation Hyperglycaemia in CP patients is associated with reduced beta cell area. However, reduced beta cell area does not predict the development of diabetes, suggesting that other factors are more important determinants of alterations in glucose metabolism in patients with CP.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Determinants of glucose control in patients with chronic pancreatitis

et al. 2010

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“…In terms of QOL, 69% of patients were professionally rehabilitated and in 72% of patients the Karnofsky index was between 90% and 100% [46]. Death rates in patients with CP who have undergone Beger procedure at 5 years of follow-up have been reported to be 9-12.6% [46,47], which is in contrast to the reported mortality of 20-35% in patients of CP without treatment who were observed over a period of 6-10 years [48][49][50]. This supports the long-term benefits of Beger procedure.…”

Section: Resectional Proceduresmentioning

confidence: 79%

Surgery for Chronic Pancreatitis

Perwaiz¹,

Singh²,

Chaudhary³

2011

Indian J Surg

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Chronic pancreatitis (CP) is progressive inflammatory process of the pancreas. Abdominal pain remains the most debilitating symptom affecting quality of life, apart from diabetes mellitus, steatorrhoea and weight loss. The treatment options have evolved over the past decades and are aimed to provide durable relief in pain with possible attempt to support or improve the failing endocrine and exocrine functions. Surgical treatment options have shown the potentials to provide superior long term results compared to the pharmacological and endoscopic modalities and are broadly divided in to drainage, resection and combination hybrid procedures. The choice is based on the morphology of the main pancreatic duct, presence of head mass and associated complication of CP. Knowing the basic nature of the disease, total pancreatectomy seems a curative option but not without significant morbidities. There is recent paradigm shift towards organ sparing surgical procedures with reasonable success. Despite recent advancement in the treatment modalities for CP the overall quality of life remains moderate which need further addressal.

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“…CP is often associated with recurrent or protracted pain that impairs quality of life [1][2][3]. The pathogenesis of pain generation in CP remains incompletely understood despite considerable research [12].…”

Section: Discussionmentioning

confidence: 99%

“…Most patients with CP have abdominal pain, maldigestion, and diabetes mellitus [1,2]. The most frequent and serious clinical symptom is abdominal pain, which occurs in at least 75% of patients suffering from CP [3]. The recurrent or protracted abdominal pain in CP is often difficult to manage and decreases patients' quality of life.…”

Section: Introductionmentioning

confidence: 99%

Medical Management of Chronic Pancreatitis: What Can Physicians Do?

Lee¹

2017

Korean J Pancreas Biliary Tract

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Background & Aims. Chronic pancreatitis (CP) is often associated with abdominal pain, which impairs quality of life. The aim of this prospective study was to clarify whether the use of a low-fat elemental diet (ED) is beneficial for managing pain in patients with CP. Methods. Seventeen CP patients with pain despite fat-restricted dietary and conventional medical treatments were enrolled in this prospective study. These patients received low-fat ED therapy in addition to restricting fat intake for 8 weeks. The change of pain severity was examined by interviewing the patient and status of analgesic use. Results. Mean serum levels of amylase and lipase at 8 weeks after the beginning of low-fat ED therapy decreased compared to those before the therapy. At 8 weeks, pain alleviation after low-fat ED therapy was reported in 15 out of 17 patients (88%). Of these 15 patients, 10 patients reported complete pain disappearance. One of 3 patients with severe or moderate pain requiring analgesic was relieved of analgesic use after low-fat ED therapy. Conclusion. Low-fat ED therapy is useful as means of pain control in CP. The therapy is recommended in outpatients with CP who present with pain despite conventional dietary and medical treatments.

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Natural Course of Chronic Pancreatitis

Cited by 147 publications

References 80 publications

Determinants of glucose control in patients with chronic pancreatitis

Determinants of glucose control in patients with chronic pancreatitis

Surgery for Chronic Pancreatitis

Medical Management of Chronic Pancreatitis: What Can Physicians Do?

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