Chronic pancreatitis is a progressive disease without curative treatment. Abdominal pain is the most predominant symptom of chronic pancreatitis that initially brings most of the patients to the physician's attention. Some studies have correlated the course of pain in chronic pancreatitis in comparison with the duration of the disease, progressing exocrine and endocrine pancreatic insufficiency, and morphological changes such as pancreatic calcification and duct abnormalities. Furthermore, the course of pain has been studied after alcohol abstinence or surgery in some groups. However, there are only few well-performed and valid studies, and some of them even have produced diversing results, in part. Further controlled studies harvoring a large number of patients in a multicenter setting should be considered. Therapeutic efforts on chronic pancreatitis have focused on palliative treatment of pain which is present in about 80% of cases. Endoscopic treatment of pain in chronic pancreatitis is useful and feasible in many patients. Selecting candidate for endotherapy is mandatory. Main indication of pancreatic stent insertion in chronic pancreatitis is the presence of an obvious ductal stricture. Complications of chronic pancreatitis are also indications of endoscopic intervention. Exocrine and endocrine insufficiencies should be meticulously managed to prevent complications and to maintain good quality of life.
English Abstract ; Humans ; Pancreatitis, Chronic/*diagnosis/*therapy

No abstract available.
Autoimmune Diseases/*diagnosis/therapy ; Humans ; Immunoglobulin G/blood ; Pancreatitis, Chronic/*diagnosis/pathology/therapy

No abstract available.
Autoimmune Diseases/*diagnosis/therapy ; Humans ; Immunoglobulin G/blood ; Pancreatitis, Chronic/*diagnosis/pathology/therapy

Acute Disease ; Humans ; Male ; Middle Aged ; Pancreatitis, Chronic ; diagnosis ; drug therapy ; Purpura, Schoenlein-Henoch ; diagnosis ; drug therapy ; Steroids ; therapeutic use ; Tomography, X-Ray Computed

Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.
Abdominal Pain/etiology ; Balloon Dilation ; Calcinosis/complications/diagnosis/physiopathology/surgery/*therapy ; Calculi/diagnosis/etiology/physiopathology/surgery/*therapy ; *Endoscopy/instrumentation ; Evidence-Based Medicine ; Humans ; Lithotripsy ; Pancreatic Ducts/physiopathology/*surgery ; Pancreatitis, Chronic/complications/diagnosis/physiopathology/surgery/*therapy ; Sphincterotomy, Endoscopic ; Stents ; Treatment Outcome

Pancreatic inflammatory disease may be classified as acute pancreatitis(AP) and chronic pancreatitis(CP) by primarily clinical criteria, with the obvious difference between them being restoration of normal function in the former and permanent residual damage in the latter. Gallstones and alcohol are the most common causes of acute pancreatitis. Abdominal pain is the major symptom. The diagnosis of AP is usually established by the presence of an increased serum amylase and lipase. CT scanning is the imaging method of choice in determining the severity and complications of AP. There are no generally recognized specific treatments for AP. Supportive therapy, which includes vigorous intravenous hydration, ample analgesia, and vascular, respiratory, and renal support as needed, remains the mainstay of therapy. CP may present as episodes of acute inflammation superimposed on a previously injured pancreas or as chronic fibrotic damage with persistent pain or malabsorption. Alcoholism is the most common cause of CP. The classic triad of pancreatic calcification, steatorrhea, and diabetes mellitus usually establishes the diagnosis of CP. ERCP and pancreatic function test are gold standard imaging procedures for diagnosing CP and planning treatment. Therapy for patients with CP is directed toward major problems such as pain, malabsorption, and diabetes mellitus. Pancreatic enzyme replacement therapy improves the abdominal pain and malabsorption. If Complications is found, endoscopic or Surgical treatments should be considered.
Abdominal Pain ; Alcoholism ; Amylases ; Analgesia ; Cholangiopancreatography, Endoscopic Retrograde ; Diabetes Mellitus ; Diagnosis ; Enzyme Replacement Therapy ; Gallstones ; Humans ; Inflammation ; Lipase ; Pancreas ; Pancreatic Function Tests ; Pancreatitis* ; Pancreatitis, Chronic ; Steatorrhea ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to review the clinical characteristics and treatment outcome of pancreatitis developed in 19 children with leukemia and lymphoma in Asan Medical Center. METHODS: Hospital and outpatient records of 19 children either with leukemia or lymphoma who developed acute pancreatitis were reviewed. Clinical characteristics of these patients along with serologic data were analysed. RESULTS: 1. Median age at diagnosis of pancreatitis in 19 patients was 11 years of age. 2. Patients had acute lymphocytic leukemia (12 cases; 53%), acute myelocytic leukemia (4 cases; 21%), non-Hodgkins lymphoma (3 cases; 16%). 3. The etiologies of pancreatitis were L-asparaginase (16 cases) therapy, continuous Ara-C therapy (2 cases) and gallbladder stone (1 case). 5. L-asparaginase realated pancreatitis developed during the course of CCG 1882 induction (7 cases), CCG 1901 onsolidation (4 cases), CCG 1901 induction (1 case), and ADCOMP induction (1 case). 6. All patients experienced abdomial pain. Nausea, fever, vomiting, abdominal distention and diarrhea were also manifested clinically. 7. Hypocalcemia, sepsis, ascites, hyperglycemia, diabetic ketoacidosis, pancreatic pseudocysts and fistula were complicating events. 8. 6 patients were dead. The causes of death were from progression of lymphoma/ leukemia itself in 5 cases. One patient died of regimen related toxicity. The period of follow-up ranged from 2 months to 6.6 years with median follow-up of 28 months. CONCLUSION: 1. It is neccessary to monitor the level of serum amylase and lipase or to perform radiologic evaluation in patients who develop abdominal pain during L-asparaginase and Ara-C therapy especially in the course of CCG 1882 induction and CCG 1901 consolidation. 2. The outcome of chemotherapy induced pancreatitis is favorable in most instances but in some patients chronic pancreatitis may remain. The delay of chemotherapy due to pancreatitis may be responsible for the relapse of cancer. Therefore, prompt diagnosis and aggressive supportive therapy are important.
Abdominal Pain ; Amylases ; Ascites ; Cause of Death ; Child* ; Chungcheongnam-do ; Cytarabine ; Diabetic Ketoacidosis ; Diagnosis ; Diarrhea ; Drug Therapy ; Fever ; Fistula ; Follow-Up Studies ; Gallbladder ; Humans ; Hyperglycemia ; Hypocalcemia ; Leukemia* ; Leukemia, Myeloid, Acute ; Lipase ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Nausea ; Outpatients ; Pancreatic Pseudocyst ; Pancreatitis* ; Pancreatitis, Chronic ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Recurrence ; Sepsis ; Treatment Outcome ; Vomiting

BACKGROUND/AIMS: The purpose of this study was to assess the clinical characteristics, recurrence features, and treatment results of patients with autoimmune pancreatitis (AIP) and to determine the clinical predictive factors associated with recurrence. METHODS: We analyzed the clinical, radiologic, laboratory, and recurrence features. We also evaluated treatment methods and outcomes, and clinical predictive factors associated with recurrence in 55 patients with AIP. RESULTS: AIP may be misdiagnosed as pancreatic cancer due to the following characteristic features: (1) clinical findings similar to those of pancreatic cancer including weight loss (60.0%), obstructive jaundice (54.5%), and recent-onset diabetes (29.1%) as the major symptoms; (2) a preponderance in elderly men (mean, 57.7 years old; male, 81.8%); (3) pancreatic mass in computer tomography (21.8%). Serum IgG/IgG4 was elevated in 67.4% of cases. Other organ involvements were noted in 43.6% of cases. All patients (52/52) received steroid treatment have shown complete resolution or marked improvement in the presenting manifestations for which steroids were instituted. After median observation period of 32.8 (1-106) months, 9 patients (3-year cumulative recurrence rate, 20.0%) recurred. There was no significant clinical predictive factor for the recurrence of AIP. However, elevated serum IgG4 preceded recurrence in all patients whose serum IgG4 levels were checked at recurrence. CONCLUSIONS: It is reasonable to understand AIP as a pancreatic lesion reflecting systemic disease, so called 'IgG4-related fibroinflammatory disease'. Steroid trial may be a practical diagnostic tool and a therapeutic one. Recurrence was not uncommon after the steroid treatment and serum IgG4 could be a monitoring marker for the recurrence in clinical practice.
Adolescent ; Adult ; Aged ; Anti-Inflammatory Agents/therapeutic use ; Autoimmune Diseases/*diagnosis/therapy ; Cholangiopancreatography, Endoscopic Retrograde ; Female ; Humans ; Immunoglobulin G/blood ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreatectomy ; Pancreatitis, Chronic/*diagnosis/pathology/therapy ; Predictive Value of Tests ; Prednisolone/therapeutic use ; Recurrence ; Tomography, X-Ray Computed ; Treatment Outcome