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Query: UMLS:C0149521 (chronic pancreatitis)
 7,199 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The practical implications of the new Marseilles classification (1984) of pancreatitis are discussed and the present-day diagnostic methods critically reviewed. The new classification distinguishes between two typical long-term profiles, i.e. acute (reversible) and chronic (progressive) pancreatitis. Modern diagnostic tests such as sonography, CT, ERCP and the secretin-CCK test do not provide a "gold standard" for early chronic pancreatitis. Thus, long-term studies of function and morphology are needed to differentiate chronic pancreatitis (progressive dysfunction, calcification, ERP changes) from acute (reversible) pancreatitis. The etiology is a helpful prognostic guide since gallstone pancreatitis virtually never becomes chronic. However, alcoholic "acute" pancreatitis may not always progress to chronic pancreatitis. Drug or surgical treatment of pain is symptomatic and empirical, since the pathomechanisms of pain are poorly understood. A prerequisite for optimum therapy is exact staging of the disease into: uncomplicated early stages with short, self-limiting episodes of pancreatitis: conservative therapy, persistent pain, mainly due to pseudocysts (diagnosis by morphological tests): surgical therapy, advanced painless forms of chronic pancreatitis associated with diabetes and/or steatorrhea: diet and substitution therapy. After successful surgical drainage persistent pain subsides, but postoperative episodic recurrences of pancreatitis are common in the early stages of the disease and in association with continued alcohol intake. However, spontaneous pain relief occurs in all cases in the late stages of the disease and with progressive pancreatic dysfunction (despite continued alcohol abuse).
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PMID:[Diagnosis and therapy of chronic alcoholic pancreatitis. A critical review of the status]. 390 86

ERP was analyzed in 87 patients with chronic pancreatitis with special reference to its clinical value in management of pain, the dominating symptom in uncomplicated chronic pancreatitis. A significant correlation was found between ductal changes due to pancreatitis and decrease in pancreatic function. However, no association was found between severe pancreatic pain and pancreatic function or pancreatic morphology. The significance of ERP in management of patients with persistent severe pancreatic pain is discussed.
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PMID:ERP in chronic pancreatitis--ductal morphology, relation to exocrine function and pain--clinical value. 405 12

A method using CT after endoscopic retrograde pancreatography (CT-ERP) is described for pancreatic imaging. When using an ERP technique in the canine model comparable to that used in humans, small amounts of contrast material in peripheral pancreatic radicles resulted in enhancement of the pancreas on CT scans. Nine patients were also studied by CT-ERP. In normal patients (n = 5) there was opacification of the entire pancreas on CT-ERP images. The main pancreatic duct was seen on delayed images. In cases of chronic pancreatitis (n = 2), pancreatic opacification was patchy and heterogeneous. There was no contrast-material enhancement in areas of pancreatic carcinomas (n = 2). CT-ERP showed the true extent of carcinoma better than ERP alone.
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PMID:Pancreas imaging by computed tomography after endoscopic retrograde pancreatography. 668 59

In 104 patients with longstanding abdominal pain of unknown origin endoscopic pancreatography was carried through after a thorough noninvasive exploration (Secretin-CCK-test included). Pancreatography revealed in 18% slight but distinct-pathological changes at the pancreatic duct system compatible with chronic pancreatitis. As the frequency of the pathological pancreatographic findings showed no correlation with duration of pain history but a significant correlation with age it is suggested that the duct changes encountered represent rather age-dependent irrelevant fibrosis of the pancreas tan clinically relevant chronic pancreatitis. Slight pathological duct changes are by themselves no proof of chronic pancreatitis because there is no possibility to discriminate between chronic pancreatitis and age-dependent fibrosis on the ground of pancreatography. ERP therefore is of little or no value in patients with otherwise insubstantial suspicion of chronic pancreatitis.
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PMID:[Frequency and significance of inflammatory pancreatic duct changes in patients with upper abdominal pain of unknown origin]. 712 18

A discrepancy between the ERP and SPT was found in 16 patients (15,4%) out of 104 examinations. The results of these examinations were compared with the clinical diagnosis. A cause of false positive results of ERP could be operations on pancreas, of SPT the advancing years of the patients. Neither ERP nor SPT has a better diagnostic significance in chronic pancreatitis.
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PMID:[A discrepancy between endoscopic retrograde pancreatography (ERP) and secretin-pancreozymin test (SPT). Attempt of an evaluation (author's transl)]. 727 54

The foregoing discussion emphasized the fact that pancreatography can document changes that are relatively specific for chronic pancreatitis but that similar changes can be seen in other clinical conditions and even as normal variants. In addition, the exact clinical implication of minor or equivocal changes is unclear and care should be taken not to overinterpret ERP findings. It also must be realized that ERP may miss a substantial number of patients with earlier or less advanced chronic pancreatitis. ERP also may document pancreas divisum, but is not helpful in explaining the patient's clinical condition in the absence of dorsal duct abnormalities. Finally, tests of pancreatic function--in particular, hormonal stimulation tests--are complementary to tests of pancreatic morphology and allow the diagnosis of less advanced or earlier chronic pancreatitis, as well as patients with divisum and normal dorsal ducts who nonetheless have obstruction to flow at the minor papilla. The evaluation of a patient with presumed chronic pancreatitis therefore should begin with simple, noninvasive tests that are able to detect advanced forms of chronic pancreatitis. These include plain abdominal radiograph and serum trypsin. If either of these is markedly abnormal, no further diagnostic testing is generally required. In patients in whom diagnostic uncertainty still exists, reasonable second-echelon tests include abdominal CT, bentiromide testing, or secretin stimulation testing. Of these, hormonal stimulation testing offers the most sensitivity but is not universally available. More invasive evaluations--in particular, ERP--should be reserved for patients in whom the diagnosis is still unclear or in whom therapeutic rather than diagnostic information is required (e.g., a patient classified a medical failure being considered for Peustow procedure).
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PMID:What does an abnormal pancreatogram mean? 772 40

ERP is an important technique in the diagnosis of diseases involving the pancreatic ducts, in determining therapeutic strategy, and in assessing the results of surgical bypass procedures. ERP facilitates the diagnosis of the majority of pancreatic tumors at a stage when they normally present to the clinician. It assists the diagnosis of small tumors in the ampullary region at an early stage when other tests are negative. In cases of obscure recurrent pancreatitis, ERP may identify a mechanical cause (e.g., stone, stricture). ERP is useful in the diagnosis of CCP only in the precalcified stage. If histologic confirmation already has been obtained at surgery, ERCP is not required. Compared with noninvasive techniques, ERP provides additional information: It enables a concomitant examination of the gastroduodenal tract and opacification of the bile ducts; additional procedures may be performed, such as intraductal cytologic brushings, biochemical and cytologic analysis of pancreatic juice, endoscopic manometry, and pancreatoscopy. The diagnostic yield is increased if these procedures are performed during ERCP. Because ERP outlines the ductal anatomy, it is of great value in assessing therapeutic strategy. In cases of acute recurrent pancreatitis or chronic pancreatitis, ERP provides an important baseline for performing procedures such as ductal drainage and therefore reduces the inappropriate use of exploratory laparotomy. In cases of necrotic pancreatitis or pancreatic trauma, ERP enables accurate localization of a pancreatic fistula and facilitates any subsequent surgical procedure. Finally, ERP is the method of choice when assessing the patency of pancreatic-digestive anastomosis.
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PMID:Retrograde pancreatography. Technical tips and spectrum of pathology. 772 51

Forty patients with pancreatic diseases (11 cancer, 1 islet cell tumor, 12 mucin-producing tumor, 1 teratoma, and 15 chronic pancreatitis) were studied in vivo with ERP and were also scanned with an intraductal ultrasound (IDUS) probe at a frequency of 30 MHz inserted into the main pancreatic duct. The usefulness of in vivo IDUS was evaluated by comparison of images with the ERP findings. IDUS was of diagnostic value in 18 of the 40 patients; it distinguished between 4 malignant and 6 benign causes of localized stenosis revealed by ERP, provided parenchymal information in 2 cases with only displacement revealed by ERP (1 islet cell tumor and 1 teratoma), and determined the extent of tumor in 6 cases with main-duct-type mucin-producing tumor. Ten of 11 cancer, 4 of 12 mucin-producing tumor, 1 islet cell tumor, and 11 of 15 chronic pancreatitis (previously scanned in vivo), and 2 islet cell tumor (not scanned in vivo), were resected and scanned in vitro. Fifteen normal pancreases from autopsy subjects were also scanned in vitro. The IDUS images were then compared with corresponding histopathological sections from the 15 normal pancreases and 28 post-operative pancreatic specimens. Differential diagnosis of the pancreatic diseases by echo patterns was possible in all cases except those with intraductal papillary adenocarcinoma and adenoma.
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PMID:Differential diagnosis of pancreatic diseases with an intraductal ultrasound system. 801 24

In this study, we investigated the relationship between pain and pancreatic pressure in patients with chronic pancreatitis (CP). We studied 12 patients with CP undergoing surgery and five controls with cancer of the pancreatic tail. CP was staged on the basis of morphological (ERP) and functional (serum-pancreolauryl test) criteria. Patients kept daily records of the intensity of pain on a linear analog scale. Intraoperatively, pressure within the pancreas was assessed by the introduction of a fine needle into the pancreatic parenchyma connected to a pressure transducer. In controls, pressure was determined in macroscopically normal tissue in the head of the pancreas. Pancreatic pressure was significantly higher in CP than in controls (29.9 +/- 3.1 vs 7.2 +/- 1.1 mmHg, p < 0.001). No relationship was found between the pain score and the pancreatic pressure. Pressure was positively correlated with ductal changes (r = 0.831; p < 0.001), but not with exocrine function of the pancreas. Postoperatively, pancreatic pressure fell by 15.3% in four patients with CP in whom pressure assessment was repeated after surgical decompression. We conclude that pancreatic parenchyma pressure is not closely related to pain in CP.
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PMID:Is increased pancreatic pressure related to pain in chronic pancreatitis? 807 69

An alcoholic man presented with bloody ascites, which was confirmed as pancreatic ascites complicating chronic pancreatitis. Endoscopic retrograde pancreatography [ERP] demonstrated a ductal disruption at the head of the pancreas, a fistulous tract, and extravasation to the peritoneal cavity. Furthermore, a computerized tomographic scan subsequent to the endoscopic retrograde pancreatography (ERP-CT scan) gave the three-dimensional anatomy of the fistulous tract by the residual contrast media in the pancreatic duct and the fistulous tract. The pancreatic ascites, which was refractory to conventional medical treatment of a 5-wk duration, was successfully treated by endoscopic placement of a pancreatic stent and administration of a somatostatin analogue.
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PMID:Three-dimensional demonstration and endoscopic treatment of pancreaticoperitoneal fistula. 780 31


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