Impact of Etiology on the Painful Early Stage of Chronic Pancreatitis: A Long-Term Prospective Study

Zusammenfassung

Hintergrund und Ziele: Die prospektive Studie hat zum Ziel den Einfluss der Aetiologie auf das Schmerzprofil in Bezug auf Veränderungen der Funktion und Morphologie von der Früh- bis zur Spätphase der chronischen Pankreatitis (CP) zu untersuchen. Methode: Unsere internistische und chirurgische Kohorte umfasste 256 Patienten mit alkoholischer (ACP), 21 mit idiopathisch juveniler (IJCP), 46 mit idiopathisch seniler (ISCP) und 11 mit hereditären CP (HP). Die Patienten wurden ab Krankheitsbeginn regelmäßig gemäß einem früher publizierten Protokoll nachkontrolliert. Resultate: Bei der ACP, IJCP und ISCP waren vorwiegend Männer betroffen (≥71 %), während es bei der HP nur 46 % waren. Das Alter bei Krankheitsbeginn (Median) betrug bei der HP 10, bei der IJCP 23, bei der ACP 36 und ISCP 62 Jahre. Die Nachbeobachtungszeit schwankte zwischen 14 - 36 Jahren. Die Progression ins Spätstadium der CP, dokumentiert anhand der exokrinen Insuffizienz (86 - 100%) und Pankreasverkalkungen (80 - 91 %) dauerte 2 bis 5mal länger bei der HP/IJCP als bei der ACP. Die Frühphase der CP, charakterisiert durch wiederholte Pankreatitisschübe, dominierte bei über 90% der Patienten ausser bei der ISCP (48 %) und dauerte mehr 5mal länger bei der HP/IJCP als bei der ACP. 57 % der ACP/IJCP Patienten mussten wegen starken Schmerzen operiert werden, verglichen mit weniger als 27 % der HP/ISCP-Patienten. Unabhängig von der Aetiologie und der chirurgischen Interventionen wurden die Patienten im Spätstadium dauerhaft schmerzfrei. Zusammenfassung: Der klinische Verlauf im Frühstadium der CP unterscheidet sich in Abhängigkeit von der zugrunde liegenden Aetiologie.

Abstract

Background and Aim: This prospective study was aimed to investigate the impact of etiology on the pain profile in relation to alterations of function and morphology from early to advanced chronic pancreatitis (CP). Methods: Our mixed medico-surgical cohort comprised 265 patients with alcoholic (ACP), 21 with idiopathic „juvenile” (IJCP), 46 with idiopathic „senile” (ISCP) and 11 with hereditary CP (HPCP). The patients were followed regularly from onset of disease according to the protocol published previously. Results: Males predominated in ACP, IJCP, ISCP (> 71 %) but not in HP (46 %). Age at onset (median) was 10, 23, 36 and 62 years in HP, IJCP, ACP and ISCP, respectively. Follow-up from disease onset ranged from 14 to 36 years. The progression to late-stage CP, documented by exocrine insufficiency (86 - 100%) and calcification (80 - 91 %) lasted 2 to 5-fold longer in HP/IJCP compared to ACP. Early stage CP, characterized by recurrent pancreatitis prevailed in ≥ 90 % of patients, except for those with ISCP (48 %), and lasted up to 5-fold longer in HP/IJCP compared to ACP. Surgery for severe pain was required for ACP/IJCP in 57 % of the patients compared to < 27 % in HP/ISCP. Permanent pain relief regularly occurred in late-stage CP irrespective of etiology and surgery. Conclusion: The clinical profile of the 4 „etiological” subgroups is predictably different in the painful early (precalcific) CP stage.

Schlüsselwörter

Pankreatitis - natürlicher Verlauf - Aetiologie

Key words

Pancreatitis - natural history - etiology

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