Tracing the Evidence to Address Painful Chronic Pancreatitis With Surgery

Chronic pancreatitis is characterized by pancreatic endocrine and exocrine insufficiency, along with persistent, and in some cases, unrelenting pain. While pancreatic insufficiency is effectively managed with pharmacologic intervention, the pain associated with this condition is difficult to control and commonly leads to severe consequences for the patient. A search of ClinicalTrials.gov for chronic pancreatitis revealed 152 studies, nearly all of which consist of interventions for pain. The current modalities, including pain medication, pancreatic enzyme replacement, behavioral therapy, endoscopic treatment, and surgery, all have varying degrees of efficacy. Less-invasive modalities include endoscopic retrograde pancreatography (ERP) with stone extraction, ERP with endoscopic lithotripsy and stent placement, and extracorporeal shock wave lithotripsy (ESWL). Surgical interventions include drainage procedures with attachment of the main pancreatic duct to the intestine or resection of the involved pancreas.
Source: JAMA - Category: General Medicine Source Type: research

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Publication date: Available online 19 February 2020Source: European Journal of RadiologyAuthor(s): Mahya Faghih, Vikesh K. Singh, Mashayekhi R, Parekh VS, Michael A. Jacobs, Atif Zaheer
Source: European Journal of Radiology - Category: Radiology Source Type: research
Publication date: Available online 19 February 2020Source: European Journal of RadiologyAuthor(s): Yu Liu, Hua-Liang Chen, Zhao-Shen Li, Dan Wang, Liang-Hao Hu
Source: European Journal of Radiology - Category: Radiology Source Type: research
Conclusions: Supplementation with AO to patients with CP causes a sustained increase in blood levels of AO; however, it has no addition benefit over PL on endocrine and exocrine functions, markers of fibrosis, OS and inflammation, nutritional status, pain and QOL. Further larger studies with adequate sample size are required.
Source: Journal of Clinical Gastroenterology - Category: Gastroenterology Tags: LIVER, PANCREAS & BILIARY TRACT: Original Articles Source Type: research
Introduction: The purpose of this study is to evaluate the efficacy and safety of acupuncture on relieving abdominal pain and distension in acute pancreatitis. Methods and analysis: We will electronically search PubMed, MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database from their inception. Furthermore, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and gray literature. The clinical ra...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Study Protocol Systematic Review Source Type: research
A 46-year-old man with a history of alcohol use disorder, tobacco use, and chronic pancreatitis complicated by an untreated pseudocyst presented with two days of right lower extremity swelling and pain, shortness of breath, and pleuritic chest pain. A right lower extremity Doppler showed a saphenous vein thrombus, and CT angiography of the chest revealed multiple bilateral segmental pulmonary emboli with involvement of the right distal main pulmonary artery. The patient had no personal or family history of venous thromboembolism, and review of systems was not concerning for an underlying oncologic or active inflammatory process.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Clinical Communication to the Editor Source Type: research
This randomized clinical trial compares the effects of pancreatic drainage surgery within 6 weeks vs a stepped medical-endoscopy-surgical approach on pain score and relief over 18 months among patients with chronic pancreatitis.
Source: JAMA - Category: General Medicine Source Type: research
Objectives: The aim of the study was to understand the association of frequent opioid use with disease phenotype and pain pattern and burden in children and adolescents with acute recurrent (ARP) or chronic pancreatitis (CP). Methods: Cross-sectional study of children
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Original Articles: Pancreatology Source Type: research
Publication date: Available online 28 December 2019Source: Journal of Pediatric Surgery Case ReportsAuthor(s): Christina B. Chadwick, Stephen Megison, David M. Troendle, Meghana SatheAbstractIndividuals with cystic fibrosis (CF) who possess milder and less common mutations can have preservation of exocrine pancreatic function (EPF) but are at risk for recurrent pancreatitis, chronic pancreatic damage, and loss of EPF. They may develop sequelae secondary to pancreatic disease including malabsorption, chronic pain, and disordered eating. In severe cases, endoscopic and surgical intervention is necessary. With advancement of ...
Source: Journal of Pediatric Surgery Case Reports - Category: Surgery Source Type: research
Publication date: Available online 27 December 2019Source: NeuroscienceAuthor(s): Qiaoling Liu, Chih-Yuan Ko, Chen Zheng, Lichao Ye, Bo Liu, Hongzhi Gao, Donghong Huang, Dylan ChouAbstractVisceral pain originating from chronic inflammation of the pancreas is often intractable and difficult to manage clinically. However, the pathogenesis of the central nervous system underlying visceral pain is still poorly understood. The aim of the present study was to investigate the role of the midbrain ventrolateral periaqueductal gray (vlPAG) in a rat model of chronic visceral pain induced by pancreatitis. In the present study, we use...
Source: Neuroscience - Category: Neuroscience Source Type: research
ConclusionsThe Puestow procedure is an acceptable treatment modality with low rates of morbidity and mortality. Minimizing transfusions and optimizing pulmonary status may improve 30-day outcomes.
Source: The American Journal of Surgery - Category: Surgery Source Type: research
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