History of the European pancreatic club: the first 40 years 1965-2005. The development of the European pancreatic club as a scientific society.

The European Pancreatic Club (EPC) was founded during a first symposium on December 9 and 10, 1965 in London (President H.T. Howat). The nine founding members were one biochemist (Jean Christophe, Belgium), one physiologist (Alfred A. Harper, UK), two surgeons (André Delcourt, Belgium, Yngve Edlund, Norway) and five physicians with special interest in the pancreas (Werner Creutzfeldt, Germany, Oliver Fitzgerald, Ireland, Karel Herfort, Czechoslovakia, Henry T. Howat, UK, Henri Sarles, France). It was the first scientific society worldwide which was concerned with the study of the pancreas. The idea was to bring basic scientists and clinicians together in an informal atmosphere to promote friendship and communication on research between them. The 2nd symposium was held in Marseilles in 1967 (President H. Sarles). Until now there have nearly always been annual meetings, the one in 2005 is the 37th. In 1973 the EPC decided to lay down 'Internal Rules' and in 1992 new statutes were introduced. It became a member of the United European Gastroenterology Federation (UEGF) and is coorganizer of the United European Gastroenterology Week (UEGW). The official journal has been Pancreatology since 2001; previously the abstracts had been printed in Digestion since 1982. The officers of the EPC are the President, the Past President, the President Elect, the Secretary, the Treasurer and six Councillors from different European countries, three from basic and three from clinical science. A selection committee (4 basic and 4 clinical scientists) decides on the acceptance of papers. Officers and Presidents are elected by the General Assembly. At the meetings on average 150 contributions are accepted for presentation; the abstracts are printed in Pancreatology. Papers came from nearly all European countries and from overseas. In numbers Germany, France, the UK, Italy and Sweden are at the top. In total 4,837 scientific presentations were made from 1971 to 2004. Fifty-nine symposia and 245 invited lectures informed about the state of the art. Since 1991 a Young Researchers Corner given by international experts is especially designed to give information on new techniques of research. The European Study Group of Pancreatic Cancer (ESPAC) and the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (EUROPAC) are affiliated with the EPC. Since 1999 a Newsletter of the EPC has been published. The website of the EPC is www.e-p-c.org.

History of the European pancreatic club: the first 40 years 1965-2005. The scientific profile of the European pancreatic club and what stood the test of time.

The invited lectures, the symposia and panels and the printed abstracts of the meetings are the basis for analysis of the development of pancreatic research over the 40 years from 1965 to 2005. 245 invited lectures and 59 symposia, panels and round tables presented and discussed the latest state of the art at the meetings of the European Pancreatic Club (EPC). We analyze in detail the contributions to physiology and biochemistry of the pancreas, the neurohormonal control of pancreatic secretion, cell biology, stimulus-secretion coupling, and cell receptors. The research on the endocrine-exocrine relationship, nutrition and the pancreas, experimental and clinical acute and chronic pancreatitis, function tests and imaging of the pancreas, pancreatic development and growth, experimental and clinical pancreatic carcinoma, genetics and inherited pancreatic diseases over the years are listed in special sections and discussed. At the center of the EPC meetings there are scientific sessions with either oral or poster presentations. From 1971 to 2004, 4,837 contributions were accepted and printed as abstracts. In the first 30 years papers on basic research usually amounted to around 30-40%, on pathophysiology also 20-40% and the rest were on clinical work. In the years since 1993 the basic contributions became less with 20% and even only 10% of all papers in the last years. Abstracts from pathophysiology and pathology increased in the 1990s, mainly with work on pancreatic carcinoma. Papers on clinical topics also rose to 40-50% of all in the years since 1998. The interest in clinical topics shifted over the years. Chronic pancreatitis was the main topic in the 1970s; in the 1980s until 2000, acute pancreatitis gained more interest, and pancreatic cancer is now an attractive field of study due to new methods of research with cancer cell lines and genetic models. Since 1993 a Young Researchers Corner with international experts is offered at the meetings of the EPC, the programs are analyzed. In the last section the question of 'what stood the test of time?' is asked as reflected in 40 years of meetings of the EPC. Topics are physiology, biochemistry and cell biology in relation to the pancreas, pathogenesis of acute and chronic pancreatitis, methods of diagnosis, treatment of pancreatitis and of carcinoma.

Severe acute pancreatitis: nonsurgical treatment of infected necroses.

OBJECTIVES: In acute pancreatitis, infection of necrosis is associated with a substantial mortality of 15% to >50% even if immediate necrosectomy, the recommended standard treatment, is performed, mainly because of the patients' critical systemic and unstable local conditions at the time of manifestation of infection. We investigated whether this dreaded complication can be managed conservatively. METHODS: We evaluated 88 consecutive patients with severe (APACHE II score, > or =11; Ranson score, > or =4) acute necrotizing pancreatitis who received ICU treatment including early antibiotic prophylaxis. Twenty-eight patients were included who developed infection of necroses, verified by fine needle aspiration, 19 +/- 6 days after admission. No patient received urgent surgery; rather, in all patients, nonsurgical therapy was continued after adapting the antibiotic regimen to bacteriology. In the further course, 12 patients were excluded due to refractory local complications eventually requiring surgical treatment 36 +/- 14 days after diagnosis of infection. RESULTS: Sixteen patients (APACHE II score: 18.1 [11-33]; Ranson score, 5.9 [4-10]) were managed with medical treatment alone. Six patients recovered without further complications; 10 patients (62%) developed single or multiple organ failure, and 2 died (mortality, 12%). CONCLUSION: These data suggest that in patients with acute necrotizing pancreatitis and infected necroses, surgery can be avoided without compromising prognosis and outcome.

Clinical presentation and personality factors are predictors of the response to treatment in patients with functional dyspepsia; a randomized, double-blind placebo-controlled crossover study.

The role of psychological factors or symptom pattern for the response to treatment in patients with unexplained (functional) dyspepsia is unknown. We hypothesized that patients with reflux- and ulcer-like symptoms would be more likely to respond to acid-lowering therapy, while psychological disturbances would be associated with a less favorable response to treatment. Seventy-eight patients with a diagnosis of functional dyspepsia were recruited and 75 completed the trial. Patients were treated for 4 weeks in a double-blind, placebo-controlled crossover trial starting in random order with either active drug (ranitidine, 150 mg b.d.) or placebo. Every 7 days, medication was switched from active drug to placebo, or vice versa. At entry, patient characteristics were assessed utilizing a semistructured standardized interview and standardized questionnaires, and weekly intensity of symptoms was assessed utilizing a visual analogue scale. Patients with a greater reduction of the symptom score during active treatment and an overall reduction of the global symptom score by more than 50% at the end of the study period were categorized as responders. Logistic regression analysis was utilized to assess the influence of symptom type and presence of psychological disturbances on the treatment response. During treatment the symptom score decreased significantly, from 32.1 +/- 1.44 (SD) to 21.3 +/- 1.9 at the end of the trial (P < 0.001). Twenty of 75 were responders. High scores for somatization (OR, 3.6; 95% Cl, 1.2-11.4), anxiety (OR, 3.3; 95% Cl, 0.9-11.8), and reflux-like symptoms (OR, 5.3; 95% Cl, 1.7-16.7) were associated with response to treatment, while dysmotility-like symptoms were associated with an unfavorable response (OR, 0.3; 95% Cl, 0.1-0.9). Symptom pattern and psychological disturbances are independent predictors of treatment response. Patients with reflux-like symptoms and greater psychological disturbances are more likely to respond to an acid-lowering compound.

Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial.

BACKGROUND & AIMS: Antibiotic prophylaxis in necrotizing pancreatitis remains controversial. Until now, there have been no double-blind studies dealing with this topic. METHODS: A total sample size of 200 patients was calculated to demonstrate with a power of 90% that antibiotic prophylaxis reduces the proportion of patients with infected pancreatic necrosis from 40% placebo (PLA) to 20% ciprofloxacin/metronidazole (CIP/MET). One hundred fourteen patients with acute pancreatitis in combination with a serum C-reactive protein exceeding 150 mg/L and/or necrosis on contrast-enhanced CT scan were enrolled and received either intravenous CIP (2 x 400 mg/day) + MET (2 x 500 mg/day) or PLA. Study medication was discontinued and switched to open antibiotic treatment when infectious complications, multiple organ failure sepsis, or systemic inflammatory response syndrome (SIRS) occurred. After half of the planned sample size was recruited, an adaptive interim analysis was performed, and recruitment was stopped. RESULTS: Fifty-eight patients received CIP/MET and 56 patients PLA. Twenty-eight percent in the CIP/MET group required open antibiotic treatment vs. 46% with PLA. Twelve percent of the CIP/MET group developed infected pancreatic necrosis compared with 9% of the PLA group (P = 0.585). Mortality was 5% in the CIP/MET and 7% in the PLA group. In 76 patients with pancreatic necrosis on contrast-enhanced CT scan, no differences in the rate of infected pancreatic necrosis, systemic complications, or mortality were observed. CONCLUSIONS: This study detected no benefit of antibiotic prophylaxis with respect to the risk of developing infected pancreatic necrosis.