Chronic pancreatitis: diagnosis and management options in Indian subcontinent
DOI:
https://doi.org/10.18203/2349-2902.isj20210961Keywords:
Chronic pancreatitis, Endocrine function, Endoscopic sphincterotomy, ERCPAbstract
Background: Chronic pancreatitis is a heterogeneous disease. More research efforts are needed to clarify further whether individuals with chronic pain due to pancreatitis report a poor quality of life that necessitates intervention services. In this study, we sought to ascertain the clinical profile of subjects with chronic pancreatitis in India, especially with regard to risk factors, clinical features and therapeutic modalities.
Methods: 50 patients of chronic pancreatitis were studied, both prospectively and retrospective. Investigations and interventions details were noted. Questionnaire for pain scoring was prepared. Persistent pain or recurrent episodes of acute pain interfering with normal lifestyle were the criteria for intervention.
Results: The most common symptom of chronic pancreatitis is long-standing pain in the middle of the abdomen. 25 patients underwent intervention in view of severe pain. In our study improvement in endocrine function after intervention was observed in 27% of patients and improvement in exocrine function was seen in 60% patients after intervention at 2 yearly follow up.
Conclusions: Surgical method and ERCP guided intervention gives superior results as compared to conservative method in management of chronic pancreatitis.
References
Zuidema PJ. Cirrhosis and disseminated calcification of the pancreas in patients with I malnutrition. Trop Geogr Med. 1959;11:70-4.
GeeVarghese PJ, Pillai VK, Joseph MP, Pitchumoni CS. The diagnosis of pancreatogenous diabetes mellitus. J Assoc Phys India. 1962;10:173-8.
Shaper AG. Chronic pancreatic disease and protein malnutrition. Lancet. 1960;l:1223.
Chandak GR, Idris MM, Reddy DN, Mani KR, Bhaskar S, Rao GV, Singh L. Absence of PRSS1 mutations and association of SPINK1 trypsin inhibitor mutations in hereditary and non-hereditary chronic pancreatitis. Gut. 2004;53:723-8.
Geevarghese PJ. Pancreatic diabetes. A clinicopathological study of growth onset diabetes with pancreatic calculi. Popular Prakashan, Bombay; 1968.
Viswanathan M, Sampath KS, Subramanyam S, Krishnaswami CV. Etiopathological and clinical angle of pancreatic diabetes from Madras. J Assoc Phys India. 1973;21:753-9.
Kaushik SP, Vohra R, Varma R. Spectrum of pancreatitis at Chandigarh. A ten years’ experience. Indian J Gastroenterol. 1983;2:9-11.
Shah SC. Chronic pancreatitis- follow up of operated cases. Indian J Gastroenterol. 1986;3:157-9.
Mohan V, Mohan R, Susheela L, Snehalatha C, Bharani G, Mahajan VK, et al. Tropical pancreatic diabetes in South India. Heterogeneity in clinical and biochemical Profile. Diabetologia. 1985;28:229-32.
Balakrishnan V. Chronic calcific pancreatitis in the Tropics. Indian J Gastroenterol. 1984;3:65-7.
Tandon R, Rai PR, Nundy S, Vashist S. A study of chronic pancreatitis at the All India Institute of Medical Sciences, New Delhi. In: Balakrishnan V. Pub Indian Society of Gastroenterology, ed. Chronic pancreatitis in India. 1st Edn. St Joseph’s Press: Trivandrum, India; 1987.
Tripathy BB, Samal KC, Mishra H. Diabetes with exocrine pancreatic diseases. In: Bajaj JS, Madan R, Shah AK, Mohan N, eds. Diabetes mellitus in developing countries. New Delhi: Interprint; 1984.
Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology. 1984;86(5 Pt l):820-8.
Ammann RW, Muellhaupt B. The natural history of pain in alcoholic chronic pancreatitis. Gastroenterology. 1999;116(5):1132-40.
Balakrishnan V, Unnikrishnan AG, Thomas V, Choudhuri G, Veeraraju P, Singh SP, et al. Chronic pancreatitis. A prospective nationwide study of 1,086 subjects from India. J Pancreas. 2008;9(5):593-600.
Lu, Z, Kame, S, Kolodecik, T, Gorelick, FS. Alcohols enhance caerulein-induced zymogen activation in pancreatic acinar cells. Am J Physiol Gastrointest Liver Physiol. 2002;282:G501.
Whitcomb, DC. Genetic predisposition to alcoholic chronic pancreatitis. Pancreas. 2003;27:321.
Maisonneuve P, Lowenfels AB, Müllhaupt B, Cavallini G, Lankisch PG, Andersen JR, et al. Cigarette smoking accelerates progression of alcoholic chronic pancreatitis. Gut. 2005;54(4):510-4.
Morton C, Klatsky AL, Udaltsova N. Smoking, coffee, and pancreatitis. Am J Gastroenterol. 2004;99:731.
Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis. Gastroenterology. 1984;86:820.
Mergener, K, Baillie, J. Chronic pancreatitis. Lancet. 1997;350:1379.
Gabbrielli A, Pandolfi M, Mutignani M, Spada C, Perri V, Petruzziello L, et al. Efficacy of main pancreatic-duct endoscopic drainage in patients with chronic pancreatitis, continuous pain, and dilated duct. Gastrointest Endosc. 2005;61(4):576-81.
Wilcox CM. Endoscopic therapy for pain in chronic pancreatitis: Is it time for the naysayers to throw in the towel? Gastrointest Endosc. 2005;61:582-6.
Axon AT, Classen M, Cotton P, Cremer M, Freeny PC, Lees WR. Pancreatography in chronic pancreatitis: international definitions. Gut. 1984;25:1107-12.
Bittner R, Butters M, Büchler M, Nägele S, Roscher R, Beger HG. Glucose homeostasis and endocrine pancreatic function in patients with chronic pancreatitis before and after surgical therapy. Pancreas. 1994;9(1):47-53.
Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion. 1993;54:148-55.