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Pancreatic morphology and function in relationship to pain in chronic pancreatitis

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Summary

The correlation of pancreatic pain and the degree of morphological and functional changes was prospectively investigated in 64 patients (45 males, 19 females) with chronic pancreatitis. All patients underwent clinical examination and diagnostic investigations by means of endoscopic retrograde pancreatography (ERP), computed tomography (CT) and exocrine pancreatic function test (secretin-ceruletide; SC). The individual tests were performed within 4 weeks in all patients. No significant correlation was found between the degree of pain and the severity of ERP and CT findings. Severe pain was found in 62% of patients with advanced ductal changes, and in 41% of patients with advanced parenchymal lesions. 58% of patients with severe pain had marked exocrine insufficiency. Ductal changes characterized by obstruction of the main pancreatic duct were most frequently associated with severe pain (58%). Less often, severe pain was associated with duct dilatation (34%) or with slight duct changes (26%). Among parenchymal lesions as revealed in CT, large cysts were most frequently related to severe pain (62%). A notable finding was that 89% of patients presenting with calcifications in CT still experienced pain and 39% of them had severe pain. The combined diagnostic approach is useful for the individual therapeutic management, but does not provide insight into the mechanisms of pain in chronic pancreatitis. *** DIRECT SUPPORT *** A00DX032 00005

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References

  1. Sarles, H., Sahel, J., Staub, J.L., Bourry, J. and Laugier, R., Chronic pancreatitis. In: H.T. Howat and H. Sarles (Eds.) The Exocrine Pancreas, W.B. Saunders, London, Philadelphia and Toronto, 1979; 402–439.

    Google Scholar 

  2. Marks, I.N., Bank, S. and Louw, J.H., Chronic pancreatitis in the Western Cape, Digestion, 1973; 9: 447–453.

    Article  PubMed  CAS  Google Scholar 

  3. Banks, P.A., Pancreatitis, Plenum, New York, 1979.

    Google Scholar 

  4. Bornman, P.C., Marks, I.N., Girdwood, A.H., Clain, J.E., Narunsky, L., Clain, D.J. and Wright, J.P., Is pancreatic duct obstruction or stricture a major cause of pain in calcific pancreatitis? Br. J. Surg., 1980; 67: 425–428.

    Article  PubMed  CAS  Google Scholar 

  5. Reimer Jensen, A., Matzen, P., Malchow-M/ℓler, A., Christoffersen, I. and The Copenhagen Pancreatitis Study Group, Pattern of pain, duct morphology and pancreatic function in chronic pancreatitis, Scand. J. Gastroenterol., 1984; 19: 334–338.

    Google Scholar 

  6. Bornman, P.C., Marks, I.N. and Girdwood, A.H., Pathogenesis of pain in chronic pancreatitis. In: K. Gyr, M.V. Singer and H. Sarles (Eds.), Pancreatitis, Concepts and Classification, Marseille, Elsevier, Amsterdam, 1984; 193–196.

    Google Scholar 

  7. Ammann, R.W., Largiader, F. and Akovbiantz, A., Pain relief by surgery in chronic pancreatitis, Scand. J. Gastroenterol., 1979; 14: 209–215.

    Article  PubMed  CAS  Google Scholar 

  8. Ammann, R.W., Akovbiantz, A., Largiader, F. and Schueler, G., Course and outcome of chronic pancreatitis, Gastroenterology, 1984; 86: 820–828.

    PubMed  CAS  Google Scholar 

  9. Axon, A.T.R., Classen, M., Cotton, P.B., Cremer, M., Freeny, P.C. and Lees, W.R., Pancreatography in chronic pancreatitis: international definitions, Gut, 1984; 25: 1107–1112.

    Article  PubMed  CAS  Google Scholar 

  10. Malfertheiner, P., Dati, F., Büchler, M. and Ditschuneit, H., Clinical significance of immunochemical lipase in chronic pancreatitis, Klin. Wschr., 1985; 63: 43–48.

    Article  PubMed  CAS  Google Scholar 

  11. Rolny, P., Lukes, P.J., Gamklou, R., Jagenburg, R. and Nilsson, H., A comparative evaluation of endoscopic retrograde pancreatography and secretin-CCK-test in the diagnosis of pancreatic disease, Scand. J. Gastroenterol., 1978; 13: 771–781.

    Google Scholar 

  12. Oguri, T., Statistical evaluation of the correlation between endoscopic retrograde cholangiopancreatography and pancreozymin-secretin test—structure and function in chronic pancreatitis. In: T. Takemoto and T. Kasugai (Eds.), Endoscopic Retrograde Cholangiopancreatography, Igaku-Shoin, Tokyo, 1979; 48–57.

    Google Scholar 

  13. Braganza, J.M., Hunt, L.P. and Warwick, R., Relationship between pancreatic exocrine function and ductal morphology in chronic pancreatitis, Gastroenterology, 1982; 82: 1341–1347.

    PubMed  CAS  Google Scholar 

  14. Malfertheiner, P., Büchler, M., Beger, H.G. and Ditschuneit, H., Exocrine pancreatic function in correlation to morphological findings (assessed by different imaging procedures) in chronic pancreatitis. In: K. Gyr, M. Singer and H. Sarles (Eds.), Pancreatitis, Concepts and Classification, Excerpta Medica, Amsterdam, 1984: 291–300.

    Google Scholar 

  15. Freeny, P.C. and Lawson, T.L., Radiology of the Pancreas, Springer Verlag, New York, 1982.

    Google Scholar 

  16. Malfertheiner, P., Maier, W., Walliser, A. et al., CT-Morphologie and exokrine Funktion bei chronischer Pankreatitis, Z. Gastroenterol., 1983; 21: 729–735.

    PubMed  CAS  Google Scholar 

  17. Warshaw, A.L., Popp, J.W. and Shapiro, R.H., Long-term patency, pancreatic function, and pain relief after lateral pancreaticojejunostomy for chronic pancreatitis, Gastroenterology, 1980; 79: 289–293.

    PubMed  CAS  Google Scholar 

  18. Taylor, R.H., Bagley, F.H., Braasch, J.W. and Warren, K.W., Ductal drainage or resection for chronic pancreatitis, Ann. Surg., 1981; 141: 28–33.

    Article  CAS  Google Scholar 

  19. Prinz, R.A. and Greenlee, H.B., Pancreatic duct drainage in 100 patients with chronic pancreatitis, Ann. Surg., 1981; 194: 313–320.

    Article  PubMed  CAS  Google Scholar 

  20. Isaksson, G. and Ihse, I., Pain reduction by an oral pancreatic enzyme preparation in chronic pancreatitis, Dig. Dis. Sci., 1983; 28: 97–102.

    Article  PubMed  CAS  Google Scholar 

  21. Slaff, J., Jacobson, D., Tillman, C.R., Curington, C. and Toskes, P., Protease-specific suppression of pancreatic exocrine secretion, Gastroenterology, 1984; 87: 44–52.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine II, University Clinic, Steinhövelstrasse 9, D-7900, Ulm, F.R.G.

    P. Malfertheiner, M. Büchler, A. Stanescu & H. Ditschuneit

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  1. P. Malfertheiner
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  2. M. Büchler
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  3. A. Stanescu
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  4. H. Ditschuneit
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Malfertheiner, P., Büchler, M., Stanescu, A. et al. Pancreatic morphology and function in relationship to pain in chronic pancreatitis. Int J Pancreatol 2, 59–66 (1987). https://doi.org/10.1007/BF02788349

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  • DOI: https://doi.org/10.1007/BF02788349

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