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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The name juvenile tropical pancreatitis syndrome (JTPS) is proposed for a disease which affects young people of both sexes in certain parts of the tropics and which is characterised by abdominal pain, diabetes, steatorrhoea, and pancreatic calcification. The condition seems to start with blockage of the pancreatic ducts by laminated secretions or inspissated mucus plugs which later calcify. Chronic pancreatitis follows. The hypothesis is that plugs are the result of pancreatic stasis due to prolonged lack of food in the stomach and/or gastroenteritis and dehydration. Most plugs are probably dislodged during convalescence when protein-containing foods are eaten and stimulate vigorous flow of pancreatic juice. The sluggish pancreatic flow produced by very-low-protein diets may not dislodge plugs. Repeated infection and anorexia can enlarge the plugs which ultimately calcify. JTPS therefore occurs in Third-World areas with a high rate of childhood infections, and where low-protein staples are taken. Cereal staples seem to reduce the incidence of JTPS in endemic areas because of their protein content.
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PMID:Pathogenesis of juvenile tropical pancreatitis syndrome. 610 87

A group of 191 patients with chronic relapsing pancreatitis was followed for about 10 years. Ninety-three of them were selected for surgery because of incapacitating painful relapses or persistent pain and were submitted to side-to-side pancreaticojejunostomy. Ninety-eight were selected for medical management. Seventeen patients died during the follow-up. The cumulative probability of pain relief, 10 years after clinical onset of the disease was 62.9% in the patients who had been submitted to surgery and 42.8% in the nonoperated patients. In the operated group, no case of further relapse was observed after a 3-year pain-free interval, but in the nonoperated group some patients complained of further painful relapses. Complete and lasting alcohol withdrawal and/or steatorrhea were significantly associated with a more favorable result in the patients who had been submitted to surgery. However, the relationship between alcohol consumption, exocrine pancreatic insufficiency, and pain behavior did not reach statistical significance in the nonoperated patients. In patients selected for and submitted to surgery, whose disease before surgery was severe because of a high frequency of painful relapses, the chance of pain relief was similar to, and to some extent higher than, that observed in patients not selected for surgery and suffering from a mild or moderate disease. Alcohol withdrawal and exocrine pancreatic insufficiency have been confirmed as being adjunctive factors toward lessening pain in patients who had been submitted to pancreaticojejunostomy.
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PMID:Evolution of pain in chronic relapsing pancreatitis: a study of operated and nonoperated patients. 619 9

To test the discriminatory potential of certain indices of pancreatic function we performed duodenal perfusion studies and measured trypsin, bicarbonate, and lactoferrin outputs, and plasma concentrations of pancreatic polypeptide and motilin in the basal state and during continuous intravenous stimulation with 100 ng kg-1h-1 Ceruletide and 1 CU kg-1h-1 secretin. The following groups were studied: 12 normal volunteers (NV), seven patients with chronic pancreatitis with steatorrhea (CPS), and seven without steatorrhea (CP). Stimulated trypsin outputs, after 45 min of stimulation, were the best discriminant among the groups (NV versus CPS, p less than 0.0005; NV versus CP, p less than 0.005; CP versus CPS, p less than 0.05). Basal trypsin outputs showed similar patterns but failed to discriminate between NV and CP. Bicarbonate outputs were less discriminatory than trypsin outputs. Lactoferrin outputs failed to discriminate, but transient high peak outputs occurred in the initial stimulation period in all four patients with calcific chronic pancreatitis, suggesting a washout phenomenon. Basal motilin levels were elevated in both groups of pancreatitis (p less than 0.05). Stimulated pancreatic polypeptide levels were lower in CPS (NV versus CPS, p less than 0.05) but higher in CP (NV versus CP, p less than 0.005). These differences were also apparent in the basal state. We conclude that the best discrimination among the three groups was achieved by measurement of trypsin outputs, after 45 min of stimulation. In addition, the pancreatic polypeptide response may be used as a marker of residual pancreatic function in chronic pancreatitis.
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PMID:Pancreatic exocrine and endocrine responses in chronic pancreatitis. 636 35

Pancreas divisum is an anatomic duct variant, which may predispose to pancreatitis. Most patients are managed conservatively, but some patients justify attempts to improve drainage. The correct surgical approach is not yet established, and there has been no series published concerning pancreatic resection in this context. A 6-year experience with resection performed in 14 patients with severe pain is reported. There were no operative deaths, and 11 patients had good pain relief; steatorrhea developed in two patients and diabetes in one. The hypothesis that pancreas divisum may cause pancreatitis is supported by examination of resection specimens after pancreaticoduodenectomy; the dorsal part showed chronic pancreatitis and the ventral portion was normal.
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PMID:Resection for pancreatitis in patients with pancreas divisum. 638 80

A new radioimmunoassay to serum trypsinogen (Cis Trypsik) was tested in several patient populations. A low serum trypsinogen level (less than 10 ng/ml) was found in 69.2% of 13 patients with chronic pancreatic insufficiency (CPI), in 100% of 10 patients with 95-100% pancreatectomy but only in 14% of 14 patients with cancer of the pancreas. A low trypsinogen level was not found in any of 68 control subjects or 10 patients with nonpancreatic steatorrhea. Nine patients with CPI or 95% pancreatectomy were retested a mean of six months after initial testing. Four of these nine (44.4%) had a significant variation in serum trypsinogen which would have led to a different diagnostic interpretation (two went from low to normal levels and two from normal to low levels). A mixed meal had little effect on serum trypsinogen levels in five of six patients with CPI, and pancreatic enzyme replacement therapy had no consistent effect on the serum trypsinogen level in seven patients with CPI or 95% pancreatectomy. It is speculated that minor subclinical episodes of focal pancreatitis may effect the serum trypsinogen level. Although there can be considerable variability using this assay, it still offers important clinical utility. A low trypsinogen level points to a chronic pancreatic process with excellent specificity. A normal trypsinogen level is of no help and should be repeated if clinical suspicion of chronic pancreatitis remains high.
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PMID:Serum trypsinogen in diagnosis of chronic pancreatitis. 648 92

A 14C-triolein breath test was carried out on 49 subjects suffering from chronic pancreatitis or from other digestive diseases, and its results were compared with the daily fecal fat excretion. The 14CO2 peak excretion was abnormal in all the subjects with a fecal fat excretion above 14 g/day, whereas individual values of 14CO2 peak excretion in subjects without steatorrhea and with a fecal fat excretion ranging from 7.1 to 14 g overlapped. The lowest value observed in patients not suffering from steatorrhea was chosen as the lower normal limit of 14CO2 peak excretion. A test sensitivity as high as 64% was attained. The correlation between fecal fat and 14CO2 peak excretion was highly significant (r = 0.802; p less than 0.0001), and it followed a negative exponential function. Therefore, small variations in the 14CO2 peak excretion can be associated with a wide range of fecal fat excretion. Well-compensated diabetes secondary to pancreatitis did not interfere with the results of the test. In conclusion, in our experience this test proved to be a qualitative diagnostic tool with a low sensitivity.
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PMID:Is the 14C-triolein breath test useful in the assessment of malabsorption in clinical practice? 673 60

The test for pancreatic exocrine function using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BTP test) does not require duodenal intubation, but misleadingly abnormal results often occur in patients with liver or bowel disease because the p-aminobenzoic acid (PABA) released by chymotrypsin hydrolysis of the peptide either is not conjugated or is malabsorbed. This study evaluated a modified BTP test, using a tracer dose of 14C-PABA to eliminate misleading results, to assess exocrine function from a single six-hour collection of urine. The test clearly distinguished all patients with pancreatic steatorrhoea from normal subjects and identified patients with less severe pancreatitis as often as did the Lundh test. Furthermore, in patients with bowel or liver disease the misleadingly abnormal results of the unmodified BTP test were eliminated by the modified test in all but one case. These findings suggest that the modified BTP test provides a practical alternative to conventional tests of pancreatic function that entail duodenal intubation.
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PMID:Preliminary evaluation of a single-day tubeless test of pancreatic function. 678 6

The comparative sensitivity of 4 tubeless pancreatic function tests was evaluated in 125 patients with proved chronic pancreatitis associated with various degrees of pancreatic insufficiency. NBT-PABA, immunoreactive trypsin (IRT), and pancreatic isoamylase (P-iso) were studied in relation to the fecal chymotrypsin test (FCT) and steatorrhea. In advanced insufficiency (steatorrhea or FCT less than 20 micrograms/g) PABA, IRT, and P-iso were pathologically low in only 70-85% of patients. In less severe pancreatic insufficiency (FCT 21-120 micrograms/g) these tests yielded pathological results in 35-53% of patients. Thus the sensitivity of the three tests was comparable and rather low. IRT values (and P-iso) were constantly low or progressively decreasing in 64% of patients (30/47) studied repeatedly over an average of 17 months. The serum enzyme tests seem, therefore, to be valuable for monitoring pancreatic insufficiency, like the FCT. This is particularly important for the differential diagnosis of acute (reversible) and chronic (progressive) pancreatitis.
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PMID:Comparative diagnostic accuracy of four tubeless pancreatic function tests in chronic pancreatitis. 698 71

Three typical clinical patterns can be distinguished based upon the experience with the long-term course in 258 cases of chronic relapsing pancreatitis. In chronic pancreatitis without local complications there is 1. an early phase, characterized by recurrent episodes of pancreatitis; 2. a late phase, characterized by the triad: absence of pain, severe global pancreatic insufficiency (diabetes/steatorrhea), and pancreatic calcifications (if any). 3. Local complications (e.g. pseudocysts) produce a different pattern characterized by persistent pain and the symptoms of the "pancreatitis tumor", which may cause many different complications such as cholostasis, gastrointestinal bleeding, duodenal obstruction etc. Local complications are observed mainly in the early phase of the disease. Late symptoms such as diabetes, steatorrhea and calcifications indicate that the pancreatitis is virtually "burned out". The occurrence of late symptoms in the course of the disease varies individually.
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PMID:[Clinical aspects and differential diagnosis of chronic pancreatitis. Emphasis on the long term course in 258 patients]. 700 6

Of 480 patients seen with pancreatitis at the Sunnybrook Medical Centre, Toronto, in the past 5 years, 5 had pancreas divisum, demonstrated by pancreatography. Clinical presentations included recurrent acute pancreatitis, chronic pancreatitis and recurrent subcutaneous fat necrosis with steatorrhea. Pancreatography demonstrated dorsal pancreatic drainage through the duct of Santorini in all cases. The luminal diameter at the orifice of the duct of Santorini, assessed at operation, was inadequate to provide normal drainage from the gland. Sphincterotomy of the duct of Santorini alone, without surgery to the duct of Wirsung or sphincter of Oddi, was performed in four patients. This relieved the pain of chronic pancreatitis, eliminated recurrent attacks of acute pancreatitis and curtailed recurrence of subcutaneous fat necrosis and steatorrhea during follow-up periods of 51, 27, 17 and 28 months respectively. One patient who refused operation continued to have recurrent pancreatitis 41 months after diagnosis.
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PMID:Treatment of pancreatitis associated with pancreas divisum by dorsal duct sphincterotomy alone. 713 15


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