Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The natural course of pain in chronic pancreatitis was followed up in 318 patients over 10.6 +/- 8.0 years (median, 9.0 years). By the end of our follow-up, a significant decline in pain in alcoholics (n = 228) and nonalcoholics (n = 90) (p < 0.001 and p < 0.03) was marred by the fact that, even after more than 10 years, 50% of alcoholics and 62% of nonalcoholics still reported pain attacks (difference insignificant). Only alcoholics had pain relief with increasing exocrine pancreatic insufficiency (p < 0.02), but 54% of alcoholics and 73% of nonalcoholics still had pain attacks despite severe, enzyme substitution-requiring exocrine pancreatic insufficiency. The development of severe endocrine pancreatic insufficiency did not significantly influence the course of pain. It is concluded that no clinically relevant differences exist in the course of pain in alcoholic and nonalcoholic chronic pancreatitis.
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PMID:The course of pain is the same in alcohol- and nonalcohol-induced chronic pancreatitis. 779 89

To study the role that continuous drinking plays in the pain of chronic pancreatitis, we have examined 67 patients with alcoholic chronic pancreatitis with pain and 29 patients without pain, and we report on their alcoholic habits. Drinking habits played a part 92 (67.6%) of 136 times in patients with pain; in 185 without pain, 86 (46.5%) had continued their drinking habit (p < 0.001). Advanced pancreatic exocrine insufficiency was seen in 27 patients; 11 of them had pain during follow-up, whereas 16 did not. The nondrinker rate was similar in patients with and without pain, whereas among 69 patients with better pancreatic exocrine function, 56 had pain episodes and 13 did not. Alcoholic consumers were significantly more in number in the pain group: 70.4% versus 35% of the no pain group (p < 0.002). Our study shows that drinking alcohol in patients with chronic pancreatitis increased the frequency of painful episodes when there was relatively good pancreatic function, whereas in severe pancreatic insufficiency drinking had less influence on the development of pain.
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PMID:Drinking habits and pain in chronic pancreatitis. 788 76

Pancreatic enzyme extracts have been used for several decades to decrease maldigestion of macro- and micronutrients due to pancreatic insufficiency and to alleviate various abdominal symptoms, including the pain of alcohol-induced chronic pancreatitis and distal intestinal obstruction. Decreasing nutrient maldigestion and malabsorption in pancreatic insufficiency is of additional critical importance because improvement in nutritional status reduces morbidity and mortality. For example, pancreatic sufficient patients with cystic fibrosis (CF) demonstrate a slower decline in pulmonary function. In spite of the recognized importance of pancreatic enzymes, several problems exist with current preparations, and as newer enzyme preparations are marketed, proper evaluation becomes critical. There is a clear need to optimize the constituents of enzyme preparations, improve manufacturing processes, and find better sources of enzymes. Other issues that need addressing include standardization of the ratios of enzymes (lipase, amylase, protease) in these products; the stability of the enzymes at room temperature; the shelf life of the finished product; whether there are significant batch-to-batch differences; and the need for a USP reference standard.
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PMID:Enzyme therapy for pancreatic insufficiency: present status and future needs. 810 63

Exocrine pancreatic insufficiency combined with pancreatic pain and endocrine pancreatic insufficiency are the leading symptoms of chronic pancreatitis. Due to the large functional reserve capacity of the gland, decompensation, i.e. steatorrhea, does not occur before lipase excretion is reduced to < or = 10% of normal. Pancreatic enzyme substitution is indicated when fecal fat excretion exceeds a critical value (normally > 15 g/day) and/or when weight loss is present. A number of studies have dealt with the problems of gastric acid inactivation of pancreatic enzyme preparations as well as their gastric emptying nonsimultaneously with the food. For the present, it is recommended that pancreatic enzyme substitution in patients with proven exocrine pancreatic insufficiency and normal gastric acid secretion be given in multiunit, acid-protected dosages. In patients with gastric hyposecretion and in those who underwent partial or total gastrectomy, enzyme substitution should be administered as granules to enable mixing and simultaneous transport of enzymes with the chyme. The ultimate aim of further scientific and clinical research remains the total abolishment of pancreatic steatorrhea.
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PMID:Enzyme treatment of exocrine pancreatic insufficiency in chronic pancreatitis. 822 69

The natural course of the classical symptoms of chronic pancreatitis, i.e. pain, exocrine and endocrine pancreatic insufficiency, was followed up in 335 patients over a median of 9.8 years (mean 11.3 +/- 8.3 years). Pain relief was not obtained in the majority of patients, even after a long-term observation of > 10 years, and severe exocrine/endocrine insufficiency, severe duct abnormalities and pancreatic calcifications developed. Alcohol abstinence failed to have a significant beneficial effect on pain. Pancreatic surgery led to pain relief immediately after operation, but later on the pain course between operated and nonoperated patients was not significantly different. Repeated exocrine pancreatic function tests in 143 patients showed that functional exocrine impairment came to a standstill (46%), or improved (11%). At the end of observation, 22% of 335 patients still had normal endocrine function and only 40% required insulin treatment. Alcohol abstinence had a significant beneficial effect on endocrine, but not on exocrine pancreatic insufficiency. Chronic pancreatitis led to a sharp increase in unemployment and retirement. Pancreatic carcinoma occurred in 3% and extrapancreatic carcinoma in 4%. The mortality rate within the observation period was 22%, pancreatitis-induced complications accounted for 13% of these deaths.
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PMID:Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. 835 56

The indication for initiation of a replacement therapy with pancreatic enzymes in the course of ongoing exocrine pancreatic insufficiency is clinically given with the appearance of loss of body weight, steatorrhea with stool fat excretion of more than 15 g per day, dyspeptic symptoms with strong meteorism, diarrhoea, and subjective misbehaviour caused by chronic pancreatitis, in rare cases with the appearance of maldigestion of proteins and carbohydrates and--under certain circumstances--for the treatment of pain in chronic pancreatitis. Due to the increase of chronic pancreatitis in recent years, the number of patients who necessarily have to be treated with enzyme replacement therapy has increased, too. The adequate replacement therapy with pancreatic enzymes, especially in patients with severe exocrine pancreatic insufficiency, is still a serious problem--requiring sufficient knowledge of the individual pathophysiological circumstances of the patient as well as the various pharmacological aspects of the different types of enzyme drugs. The most important clinical aim of the replacement therapy is the necessity to achieve a sufficient lipase activity in the duodenum. Accordingly the achievement of this aim is the main problem in clinical practice, since the acid-instable lipase is predominantly inactivated by gastric acid and proteases. Furthermore, in many cases an asynchronous gastroduodenal transport of the administered enzyme drug and food is found as a result of inadequate size of the drug or drug particles. In general, the necessary doses of administered enzymes does not follow general rules, but has to be adjusted individually. Recent scientific developments, as the characterization of an acid-stable bacterial lipase, the cloning of human acid-stable lipase, the transfection of human lipase genes by virus-mediated gene transfer as well as the development of very small acid-stable mini microspheres, present interesting new perspectives to further optimize the efficacy of the therapy of exocrine pancreatic insufficiency in the near future.
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PMID:[Differential therapy of exocrine pancreatic insufficiency--current aspects and future prospects of substitution therapy with pancreatic enzymes]. 858 55

The natural history of alcoholic chronic pancreatitis is well-known. Patients who are the most frequently involved by the disease are 40-50 year old men. About 15,000 patients have chronic pancreatitis in France. The first symptoms occur after 10-20 years of alcohol abuse. Pain is the first symptom in 80% of patients and acute pancreatitis in one third of them. During the 5 first years of the course, pseudocyst or common bile duct compression may occur. Between the 5th-10th years of the course, acute bouts are rare but the risk of pseudocyst and extrahepatic cholestasis remains high. Therefore, patients may still undergo surgery. On the other hand, the proportion of pain free patients increases. After the 10th year of the disease, pancreatic calcifications are frequent and exocrine and endocrine pancreatic insufficiency occurs in the majority of patients.
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PMID:[Natural history of chronic pancreatitis]. 873 38

Analgesics and pancreatic extracts are required for the management of pancreatic pain. The use of pancreatic enzymes supplements is necessary for the management of pancreatic insufficiency. Patients with diabetes should be treated with insulin since endogenous insulin secretion is decreased. Drainage procedures of the pancreatic ducts, drainage of pancreatic cysts and biliary prosthesis are different ways of endoscopic management for chronic pancreatitis and its related complications. Endoscopic drainage procedures of the pancreatic duct include pancreatic sphincterotomy, extraction of pancreatic stones by means of balloons or baskets or extra corporeal shock wave lithotripsy, pancreatic duct endoprosthesis. Clinical and anatomical results are good or fair in about two thirds of the cases but there are not yet controlled studies. Endoscopic management of pancreatic cysts use transmural drainage of cysts in contact with the stomach or duodenal wall or transpapillary drainage in cysts communicating with the pancreatic ductal system. The results and complications of the endoscopic treatment of pancreatic cysts are comparable to those of surgical series. Biliary stenting is an alternative to surgical diversion. Endoscopic management of chronic pancreatitis requires the development of new techniques which should be evaluated in further controlled studies.
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PMID:[Medical and endoscopic treatment of chronic pancreatitis]. 873 39

From 1978 to 1995, 120 patients (105 males, 15 females, mean age: 46 years) underwent pancreatico jejunostomy (PJ) for chronic pancreatitis (CP). Alcohol abuse was presented in 105 cases (87.5%). PJ was the unique procedure in 67 cases; it was associated with a biliary or a duodenal diversion in respectively 38 cases and 5 cases. In ten cases, three diversions were performed. Postoperative mortality was 1.6% (n = 2), postoperative morbidity was 10% (n = 12). Mean hospital stay was 16 days. Fifteen patients (13%) required a second operation some years subsequent to the PJ, due to the progress of the CP or alcohol abuse. In the late postoperative course 22 deaths occurred (18.5%), 8 of them were directly related to alcohol abuse. Mean follow-up was 7 years. Good and medium results for pain were evaluated to 92%, but the progression of exocrine or endocrine pancreatic insufficiency indicates that wirsung decompression was insufficient to stop the progressive sclerosis. In conclusion, PJ was our preferred surgical procedure in CP treatment, when the wirsung was dilated.
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PMID:[The role of pancreatojejunostomy in the treatment of chronic pancreatitis]. 977 91

The authors summarize the principles of conservative treatment of chronic pancreatitis with special attention to treatment of exocrine pancreatic insufficiency and pancreatic pain. They emphasize the principles of the rational administration of drugs with pancreatin, the position of analgesics, and other possible procedures, if medicamentous treatment fails. An outline of dietetic treatment is also given.
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PMID:[Principles of conservative treatment in chronic pancreatitis]. 1104 24


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