Matthew J. DiMagno; Eugene P. DiMagno

Disclosures

Curr Opin Gastroenterol. 2013;29(5):531-536. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: We review selected important clinical observations reported in 2012.

Recent findings: Celiac disease is a risk factor for pancreatitis. Patients with recurrent acute pancreatitis likely have chronic pancreatitis, do not benefit from pancreatic sphincterotomy, and may not benefit from biliary sphincterotomy. Analysis of endoscopic ultrasonography (EUS) images with an artificial neural network (ANN) program may improve chronic pancreatitis diagnosis compared with clinical interpretation of images. In a multicenter, randomized controlled trial of chronic pancreatitis patients, 90 000 USP U of pancreatin with meals decreased fat malabsorption compared with placebo. Detection of visceral pain in chronic pancreatitis predicts pain relief from various treatments, but nonvisceral pain due to altered central pain processing may respond to agents such as pregabalin. Predictors of surgical pain relief include onset of symptoms less than 3 years and preoperatively no opioid use and less than five endoscopic procedures. Total pancreatectomy for presumed painful chronic pancreatitis remains controversial.

Summary: Celiacs are at risk for pancreatitis. The diagnosis of chronic pancreatitis may be enhanced by ANN analysis of EUS imaging. Treatment of fat malabsorption requires 90 000 USP U of lipase with meals. Relief of pain from organ directed treatment of chronic pancreatitis may depend upon timing of interventions and whether pain is visceral or nonvisceral.

Introduction

Currently, there is no definite medical treatment for pancreatic inflammation, fibrosis or pain of chronic pancreatitis. In this review, we focus on the association between celiac disease and pancreatitis, impact of biliary and pancreatic sphincterotomy on recurrent acute pancreatitis (RAP), differentiation between pancreatic cancer and chronic pancreatitis, dosing of pancreatic enzyme replacement therapy (PERT) to treat exocrine pancreatic insufficiency (EPI), detecting visceral pain as a predictor for pain relief to various treatments, predictors of pain relief from surgery and effectiveness of antioxidants and total pancreatectomy to treat painful chronic pancreatitis.

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