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Complications of Chronic Pancreatitis

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Abstract

Chronic pancreatitis is a disease that leads to irreversible changes in the pancreatic morphology and function. The loss of function can lead to diabetes mellitus and exocrine pancreatic insufficiency. The inflammation and fibrosis can also lead to other complications including a chronic abdominal pain syndrome, metabolic bone disease, and pancretic cancer. This article reviews our current understanding of the mechanisms and management of these complications of chronic pancreatitis.

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Abbreviations

BMD:

Bone mineral density

CP:

Chronic pancreatitis

CCK:

Cholecystokinin

EPI:

Exocrine pancreatic insufficiency

PDAC:

Pancreatic ductal adenocarcinoma

PERT:

Pancreatic enzyme replacement therapy

DM:

Diabetes mellitus

T3cDM:

Type 3c diabetes mellitus

PFT:

Pancreatic function testing

TZD:

Thiazolidinediones

GLP-1:

Glucagon-like peptide-1

GIP:

Glucose-dependent insulinotropic polypeptide

SVT:

Splenic vein thrombosis

References

  1. Majumder S, Chari ST. Chronic pancreatitis. Lancet. 2016;387:1957–1966.

    Article  PubMed  Google Scholar 

  2. Hart PA, Bellin M, Andersen DK. Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. Lancet Gastroenterol Hepatol. 2016;1:226–237.

    Article  PubMed  Google Scholar 

  3. Ewald N, Kaufmann C, Raspe A, et al. Prevalence of diabetes mellitus secondary to pancreatic diseases (type 3c). Diabetes Metab Res Rev. 2012;28:338–342.

    Article  CAS  PubMed  Google Scholar 

  4. Hart PA, Conwell DL. Diagnosis of exocrine pancreatic insufficiency. Curr Treat Options Gastroenterol. 2015;13:347–353.

    Article  PubMed  Google Scholar 

  5. Malka D, Hammel P, Sauvanet A, et al. Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology. 2000;119:1324–1332.

    Article  CAS  PubMed  Google Scholar 

  6. Ewald N, Hardt PD. Diagnosis and treatment of diabetes mellitus in chronic pancreatitis. World J Gastroenterol. 2013;19:7276–7281.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lundberg R, Beilman GJ, Dunn TB, et al. Early alterations in glycemic control and pancreatic endocrine function in nondiabetic patients with chronic pancreatitis. Pancreas. 2016;45:565–571.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Brunicardi FC, Chaiken RL, Ryan AS, et al. Pancreatic polypeptide administration improves abnormal glucose metabolism in patients with chronic pancreatitis. J Clin Endocrinol Metab. 1996;81:3566–3572.

    CAS  PubMed  Google Scholar 

  9. Rickels MR, Bellin M, Toledo FG, et al. Detection, evaluation and treatment of diabetes mellitus in chronic pancreatitis: recommendations from PancreasFest 2012. Pancreatology. 2013;13:336–342.

    Article  CAS  PubMed  Google Scholar 

  10. Li D, Yeung SC, Hassan MM, et al. Antidiabetic therapies affect risk of pancreatic cancer. Gastroenterology. 2009;137:482–488.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zhou X, You S. Rosiglitazone inhibits hepatic insulin resistance induced by chronic pancreatitis and IKK-beta/NF-kappaB expression in liver. Pancreas. 2014;43:1291–1298.

    Article  CAS  PubMed  Google Scholar 

  12. Forsmark CE. Incretins, diabetes, pancreatitis and pancreatic cancer: what the GI specialist needs to know. Pancreatology. 2016;16:10–13.

    Article  PubMed  Google Scholar 

  13. DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973;288:813–815.

    Article  CAS  PubMed  Google Scholar 

  14. Layer P, Yamamoto H, Kalthoff L, et al. The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology. 1994;107:1481–1487.

    Article  CAS  PubMed  Google Scholar 

  15. Hart PA, Topazian M, Raimondo M, et al. Endoscopic pancreas fluid collection: methods and relevance for clinical care and translational science. Am J Gastroenterol. 2016;111:1258–1266.

    Article  CAS  PubMed  Google Scholar 

  16. Sandhu BS, Hackworth WA, Stevens S, et al. Recurrent flares of pancreatitis predict development of exocrine insufficiency in chronic pancreatitis. Clin Gastroenterol Hepatol. 2007;5:1085–1091. (quiz 1007).

    Article  PubMed  Google Scholar 

  17. Martinez-Moneo E, Stigliano S, Hedstrom A, et al. Deficiency of fat-soluble vitamins in chronic pancreatitis: a systematic review and meta-analysis. Pancreatology. 2016;16:988–994.

    Article  CAS  PubMed  Google Scholar 

  18. Forsmark CE. Management of chronic pancreatitis. Gastroenterology. 2013;144:e3.

    Article  Google Scholar 

  19. Frulloni L, Falconi M, Gabbrielli A, et al. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis. 2010;42:S381–S406.

    Article  PubMed  Google Scholar 

  20. Dominguez-Munoz JE. Pancreatic exocrine insufficiency: diagnosis and treatment. J Gastroenterol Hepatol. 2011;26:12–16.

    Article  PubMed  Google Scholar 

  21. Hart PA, Conwell DL. Challenges and updates in the management of exocrine pancreatic insufficiency. Pancreas. 2016;45:1–4.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. Tignor AS, Wu BU, Whitlock TL, et al. High prevalence of low-trauma fracture in chronic pancreatitis. Am J Gastroenterol. 2010;105:2680–2686.

    Article  PubMed  Google Scholar 

  24. Munigala S, Agarwal B, Gelrud A, et al. Chronic pancreatitis and fracture: a retrospective, population-based veterans administration study. Pancreas. 2016;45:355–361.

    Article  PubMed  Google Scholar 

  25. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144:1252–1261.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Algul H, Treiber M, Lesina M, et al. Mechanisms of disease: chronic inflammation and cancer in the pancreas—a potential role for pancreatic stellate cells? Nat Clin Pract Gastroenterol Hepatol. 2007;4:454–462.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  CAS  PubMed  Google Scholar 

  28. Raimondi S, Lowenfels AB, Morselli-Labate AM, et al. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol. 2010;24:349–358.

    Article  PubMed  Google Scholar 

  29. Chari ST, Mohan V, Pitchumoni CS, et al. Risk of pancreatic carcinoma in tropical calcifying pancreatitis: an epidemiologic study. Pancreas. 1994;9:62–66.

    Article  CAS  PubMed  Google Scholar 

  30. Brodovicz KG, Kou TD, Alexander CM, et al. Impact of diabetes duration and chronic pancreatitis on the association between type 2 diabetes and pancreatic cancer risk. Diabetes Obes Metab. 2012;14:1123–1128.

    Article  CAS  PubMed  Google Scholar 

  31. Munigala S, Singh A, Gelrud A, et al. Predictors for pancreatic cancer diagnosis following new-onset diabetes mellitus. Clin Transl Gastroenterol. 2015;6:e118.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Agarwal AK, Raj Kumar K, Agarwal S, et al. Significance of splenic vein thrombosis in chronic pancreatitis. Am J Surg. 2008;196:149–154.

    Article  PubMed  Google Scholar 

  33. Butler JR, Eckert GJ, Zyromski NJ, et al. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford). 2011;13:839–845.

    Article  Google Scholar 

  34. Harris S, Nadkarni NA, Naina HV, et al. Splanchnic vein thrombosis in acute pancreatitis: a single-center experience. Pancreas. 2013;42:1251–1254.

    Article  PubMed  Google Scholar 

  35. Levy MJ, Wong Kee Song LM. EUS-guided angiotherapy for gastric varices: coil, glue, and sticky issues. Gastrointest Endosc. 2013;78:722–725.

    Article  PubMed  Google Scholar 

  36. Varadarajulu S, Bang JY, Sutton BS, et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145:e1.

    Article  Google Scholar 

  37. Gurusamy KS, Pallari E, Hawkins N, et al. Management strategies for pancreatic pseudocysts. Cochrane Database Syst Rev. 2016;4:CD011392.

    PubMed  Google Scholar 

  38. Vijungco JD, Prinz RA. Management of biliary and duodenal complications of chronic pancreatitis. World J Surg. 2003;27:1258–1270.

    Article  PubMed  Google Scholar 

  39. Oza VM, Skeans JM, Muscarella P, et al. Groove pancreatitis, a masquerading yet distinct clinicopathological entity: analysis of risk factors and differentiation. Pancreas. 2015;44:901–908.

    Article  PubMed  Google Scholar 

  40. Costamagna G, Boskoski I. Current treatment of benign biliary strictures. Ann Gastroenterol. 2013;26:37–40.

    PubMed  PubMed Central  Google Scholar 

  41. Deviere J, Nageshwar Reddy D, Puspok A, et al. Successful management of benign biliary strictures with fully covered self-expanding metal stents. Gastroenterology. 2014;147:385–395. (quiz e15).

    Article  PubMed  Google Scholar 

  42. Haapamaki C, Kylanpaa L, Udd M, et al. Randomized multicenter study of multiple plastic stents vs. covered self-expandable metallic stent in the treatment of biliary stricture in chronic pancreatitis. Endoscopy. 2015;47:605–610.

    Article  PubMed  Google Scholar 

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Acknowledgments

Research reported in this publication was supported by the National Cancer Institute and National Institute of Diabetes And Digestive and Kidney Diseases (NIDDK) under Award Number U01DK108327 (PH, DC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Section of Pancreatic Disorders, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 West Tenth Avenue, Columbus, OH, 3210, USA

    Mitchell L. Ramsey, Darwin L. Conwell & Phil A. Hart

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  1. Mitchell L. Ramsey
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  2. Darwin L. Conwell
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  3. Phil A. Hart
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Correspondence to Phil A. Hart.

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Conflict of interest

Hart (Abbvie, Inc., honorarium for speaking and KC Specialty Therapeutics, LLC, consulting fees).

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Ramsey, M.L., Conwell, D.L. & Hart, P.A. Complications of Chronic Pancreatitis. Dig Dis Sci 62, 1745–1750 (2017). https://doi.org/10.1007/s10620-017-4518-x

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