Pancreatitis crónica: análisis de factores de progresión de la enfermedad / Chronic pancreatitis: analysis of disease progression factors

BACKGROUND: Alcohol and tobacco are important risk factors for chronic pancreatitis (CP). AIM: To analyze the effect of etiological factors such as tobacco and alcohol and pancreatic enzyme replacement therapy (PERT) in the progression of CP. MATERIAL AND METHODS: Patients with a diagnosis of CP were recruited and grouped according to variables such as tobacco, alcohol and PERT. They were followed for 18 months. Subsequently, different variables and analytical parameters involved in the progression of the disease were analyzed. RESULTS: A total of 50 patients diagnosed with CP were included. Of these, 28 patients underwent PERT, 39 were smokers and 33 were alcohol users. Compared with patients without PERT, those with PERT had a higher proportion of diabetes (64 and 32%, respectively), had a higher need for endoscopic treatment (25 and 0%, respectively) and a normal body mass index (71 and 27.3%, respectively. The smokers had higher calcium levels and increased lymphocytosis and leukocytosis. The alcohol consumption group had a higher mean age (p = 0.04) CONCLUSIONS: PERT may improve the nutritional status but does not reduce the need for endoscopic or surgical treatment. Smoking and alcohol consumption favored the progression of CP. Also, smoking induced a pro-inflammatory state.

Alcoholic vs. non-alcoholic chronic pancreatitis: surgeons' perspective from a tertiary centre in india / Perspectiva dos cirurgiões sobre pancreatite crônica alcoólica vs. não-alcoólica de um centro terciário na índia

ABSTRACT Background: Although alcohol is the most common cause for chronic pancreatitis worldwide, idiopathic type is prevalent in India. Natural history and disease progression are different between these two groups. There is paucity of data comparing surgical outcome and quality of life in these patients. Aim: To evaluate clinical features, surgical outcome and quality of life between these two groups of patients. Method: All patients with chronic pancreatitis who underwent surgery were prospectively reviewed. Results: From 98 patients, 42 were alcoholic. Number of male and the mean age at the time of operation was significantly more in alcoholic patients. Smoking, preoperative hospital admission rate and the prevalence of local complications like inflammatory pancreatic head mass, biliary stricture and left sided portal hypertension were distinctly more common in alcoholic group. Frey procedure was required more commonly in alcoholic group. Mean postoperative hospital stay and overall postoperative complication rate were comparable between the two groups. Over a median follow up of 18 months there was significant improvement in quality of life and pain score in both the groups. Improvement of physical functioning score at follow-up was significantly more in alcoholic group but the requirement for analgesic medications were significantly more in alcoholic group. However, appetite loss was more perceived by non-alcoholic group. Conclusion: Alcoholic chronic pancreatitis presents with more local complications associated with chronic pancreatitis. Frey procedure is a safe and well accepted surgery in this group. Though they required more analgesic requirement in short term follow up, other aspects of quality of life are similar to non-alcoholic group.

RESUMO Racional: Embora o álcool seja a causa mais comum de pancreatite crônica em todo o mundo, a forma idiopática é prevalente na Índia. A história natural e a progressão da doença são diferentes entre esses dois grupos. Há escassez de dados comparando o resultado cirúrgico e a qualidade de vida entre eles. Objetivo: Avaliar as características clínicas, o resultado cirúrgico e a qualidade de vida entre esses dois grupos de pacientes. Método: Todos os pacientes com pancreatite crônica operados foram revisados ​​retrospectivamente. Resultados: Do total de 98 pacientes, 42 eram alcoolistas. O número de homens e a idade média no momento da operação foi significativamente maior nos alcoolistas. Tabagismo, taxa de internação pré-operatória e prevalência de complicações locais como massa inflamatória da cabeça do pâncreas, estenose biliar e hipertensão portal do lado esquerdo foram distintamente mais comuns no grupo de alcoolistas e o procedimento de Frey foi exigido mais comumente neste grupo. A média de internação pós-operatória e a taxa geral de complicações pós-operatórias foram comparáveis ​​entre os dois grupos. Ao longo de acompanhamento médio de 18 meses houve melhora significativa na qualidade de vida e pontuação de dor em ambos os grupos. A melhora no escore de funcionamento físico foi significativamente maior no grupo de alcoolistas, mas a necessidade de medicamentos analgésicos foi significativamente maior nos alcoolistas. No entanto, a perda de apetite foi mais percebida pelo grupo não alcoólico. Conclusão: A pancreatite crônica alcoólica se apresenta com mais complicações locais associadas à pancreatite crônica. O procedimento de Frey é operação segura e bem aceita neste grupo. Embora exigissem mais necessidade de analgésicos no acompanhamento em curto prazo, outros aspectos da qualidade de vida são semelhantes ao grupo não alcoólico.

¿Es la pancreatitis crónica una enfermedad rara en Chile?: ¿Subdiagnóstico, baja prevalencia o ambos? / Chronic pancreatitis: retrospective review of 121 cases

Background: Chronic pancreatitis (CP) is a rare disease in Chile, without a clear explanation for this low prevalence. Aim: To analyze the characteristics of our patients with pancreatitis. Material and Methods: Retrospective analysis of a database of patients with pancreatitis of a clinical hospital. Morphological proof of diagnosis (calcifications/calculi, alterations of ducts, local complication or histology) was obtained for every patient. History of acute pancreatitis was recorded and exocrine-endocrine function was assessed. Results: We retrieved information of 121 patients with pancreatitis (86 males) in a period of 20 years. The number of cases increased markedly every five years. The calculated incidence and prevalence was 0.8/100,000/year and 6/100,000, respectively. Pancreatic calcifications were initially observed in 93 patients and became evident during the follow-up in another six patients. Severe pain or local complications occurred in 27 patients, requiring surgery in 10 or endoscopic treatment in 15. During the years of follow-up, 55 patients were free of symptoms. Exocrine and endocrine insufficiency was demonstrated and treated in 81 and 67 patients, respectively. Alcoholic etiology was evident in 40% of patients. In 29% no etiology was identified. Mapuche origin was exceptional. Conclusions: Late diagnosis of CP is common, since most of our patients presented with advanced stages. Even though CP is increasingly diagnosed in our hospitals, the number of cases is still far fewer when compared to other countries. Underdiagnosis alone cannot explain this difference and genetic factors might be of importance.

Prevalência da pancreatite crônica em pacientes portadores de cirrose hepática alcoólica: estudo histopatológico / Prevalence of chronic pancreatitis in patients with alcoholic liver cirrhosis: histopathological study

INTRODUÇÃO: O abuso crônico do álcool é importante causa de cirrose hepática e de pancreatite crônica. OBJETIVO: Avaliar a frequência de pancreatite crônica (PC) em pacientes portadores de cirrose hepática alcoólica (CHA) por exame histopatológico. Casuística: Analisaram-se necropsias de 18 homens e sete mulheres portadores de CHA, com idade média e desvio padrão de 47,2 ± 13,8 anos (24 a 83 anos), que consumiam em média 239,6 ± 155,3 g de etanol/dia por um período médio de 16,7 ± 7,2 anos. MÉTODOS: O diagnóstico histopatológico de cirrose hepática baseou-se na fibrose sistematizada com formação de septos delimitando nódulos, associada à inflamação crônica inespecífica. O diagnóstico histológico de PC baseou-se na identificação de exsudato mononuclear (EM) em torno dos ductos e no tecido conjuntivo inter e intralobular, acompanhado de traves de fibrose. A PC foi classificada como leve quando havia discreto EM em região periductal, interlobular ou intralobular acompanhado por finas traves de fibrose; moderada, pelo aumento da intensidade do exsudato e da fibrose, ocasionalmente associado com pequena dilatação dos ductos; a forma grave caracterizou-se pelo EM, densa fibrose, presença de rolhas, dilatação dos ductos, atrofia glandular e, às vezes, calcificação. RESULTADOS: Observou-se PC em 20 pacientes portadores de CHA (80 por cento), que foi leve em 13 (52 por cento), moderada em dois (8 por cento) e grave em cinco (20 por cento). CONCLUSÃO: A pancreatite crônica está frequentemente associada à CHA, sendo histologicamente grave em aproximadamente 1/4 dos casos.

INTRODUCTION: The chronic alcohol abuse is an important cause of liver cirrhosis and chronic pancreatitis. OBJECTIVE: To evaluate the prevalence of chronic pancreatitis (CP) in patients with alcoholic liver cirrhosis (ALC) based on histopathological assays. Subjects: Autopsies of 25 patients with ALC, 18 men and seven women, age ranging from 24 to 83 years (mean ± standard deviation: 47.2 ± 13.8) were retrospectively analyzed. They ingested on average 239.6 ± 155.3 g ethanol/day for a mean period of 16.7 ± 7.2 years. METHODS: Liver cirrhosis histopathological diagnosis was based on the findings of systemized fibrosis with formation of septum-delimited nodules and nonspecific chronic inflammation. CP histopathological diagnosis was based on identification of mononuclear cell infiltration (MCI) around the ducts and in the inter- and intra-lobular connective tissue and presence of strands of fibrosis. CP was classified as mild (discrete MCI in the periductal, inter- or intra-lobular areas with thin strands of fibrosis), moderate (increased exudates and fibrosis, occasionally associated with small dilatation of ducts), and severe (evident MCI, dense fibrosis, presence of plugs in the ducts, irregular ductal dilatation, glandular atrophy and, sometimes, calcification). RESULTS: CP was observed in 20 patients (80 percent) with ALC, and was considered mild in 13 (52 percent), moderate in two (8 percent) and severe in five (20 percent) patients. CONCLUSION: CP is often associated with the ALC, and it can be histologically severe in approximately 1/4 of the cases.