review of literature on clinical pancreatology - The Pancreapedia

- pain should be assessed in a standardized and repeatable fashion prior to initiating atherapeutic trial <strong>of</strong> pancreatic enzymes. This could be as simple as using a 10-cmvisual-analog pain scale which is widely available and takes just seconds for a patientto fill out- therapeutic trials should be limited in time to 6 weeks with uncoated enzymes andconcurrent acid suppression, at which point another standardized pain measurementquestionnaire should be filled out- if the clinician feels that narcotics should be a part <strong>of</strong> the pain management strategyfor a patient, pill counts should be part <strong>of</strong> routine pain assessment at clinic visits- alcohol rehabilitation should be considered for any patient with ongoing alcohol abuse– before beginning therapy with enzyme supplements- since only one study has shown significant reductions in pain with coated pancreaticenzymes they would not recommend their use in painful chronic pancreatitis ingeneralSafety <strong>of</strong> pancreatic enzyme supplementationTo evaluate the efficacy and safety <strong>of</strong> a pancreatic enzyme preparation specificallydeveloped for infants and small children with cystic fibrosis (CF) 12 patients with CF youngerthan 24 months with pancreatic exocrine insufficiency and a coefficient <strong>of</strong> fat absorption(CFA) less than 70 percent were treated with Creon for Children (Solvay PharmaceuticalsGmbH, Hannover, Germany) minimicrospheres for 8 weeks. The primary end point was themean change from baseline in the CFA after 2 weeks <strong>of</strong> treatment, based on 72-hour fatbalance assessments. Two weeks' treatment with Creon for Children resulted in a significantincrease in the mean CFA from 58 percent at baseline to 85 percent in the full analysissample. There was a significant reduction <strong>of</strong> mean stool fat and mean fecal energy loss at 2weeks. Dietary fat intake did not change, whereas an improvement was observed in stoolfrequency and characteristics. Patient weight and height increased over 8 weeks <strong>of</strong>treatment. No serious adverse event was reported [270].Surgical interventionsOutcome <strong>of</strong> pancreatoduodenectomyPancreatic resection can be performed to ameliorate the sequelae <strong>of</strong> chronic pancreatitis inselected patients. The perceived risk <strong>of</strong> pancreatectomy may limit its use. Using a nationaldatabase, this study compared mortality after pancreatic resections for chronic pancreatitiswith those performed for neoplasm. Patient discharges with chronic pancreatitis or pancreaticneoplasm were queried from the Nationwide Inpatient Sample, 1998 to 2006. To account forthe Nationwide Inpatient Sample weighting schema, design-adjusted analyses were used.There were 11,048 pancreatic resections. Malignant neoplasms represented 64 percent <strong>of</strong>the sample; benign neoplasms and pancreatitis comprised 17 percent and 19 percent,respectively. In-hospital mortality rates were 2.2 percent and 1.7 percent for the pancreatitisand benign tumor cohorts, respectively, compared with 5.9 percent for the malignancycohort, which was a significant difference. A multivariable logistic regression examineddifferences in mortality among diagnoses while adjusting for patient and hospitalcharacteristics; covariates included patient gender, race, age, comorbidities, type <strong>of</strong>pancreatectomy, payor, hospital teaching status, hospital size, and hospital volume. Afteradjustment, patients undergoing resection for pancreatitis were at a significantly lower risk <strong>of</strong>in-hospital mortality when compared with those with malignant neoplasm (odds ratio, 0.43;95 % confidence interval 0.28 to 0.67). Pancreatectomies for chronic pancreatitis have lowerin-hospital mortality than those performed for malignancy and similar rates as resection forbenign tumors. Pancreatic resection, which can improve quality <strong>of</strong> life in chronic pancreatitis