Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings.
Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings.
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DOI：
10.1016/j.cgh.2014.10.015
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发表时间：
2015-03
期刊：
影响因子：
--
通讯作者：
Anderson MA
中科院分区：
文献类型：
--
作者：
Wilcox CM;Yadav D;Ye T;Gardner TB;Gelrud A;Sandhu BS;Lewis MD;Al-Kaade S;Cote GA;Forsmark CE;Guda NM;Conwell DL;Banks PA;Muniraj T;Romagnuolo J;Brand RE;Slivka A;Sherman S;Wisniewski SR;Whitcomb DC;Anderson MA
Chronic pancreatitis is characterized by inflammation, atrophy, fibrosis with progressive ductal changes, and functional changes that include variable exocrine and endocrine insufficiency and multiple patterns of pain. We investigated whether abdominal imaging features accurately predict patterns of pain. We collected data from participants in North American Pancreatitis Study 2 Continuation and Validation, a prospective multicenter study of patients with chronic pancreatitis performed at 13 expert centers in the United States from July 2008 through March 2012. Chronic pancreatitis was defined based on detection of characteristic changes by cross-sectional abdominal imaging, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, or histology analyses. Patients were asked by a physician or trained clinical research coordinator if they had any abdominal pain in the year before enrollment; those that responded “yes” were asked to select from a list of 5 pain patterns. Using these patterns, we classified patients’ pain based on timing and severity. Abnormal pancreatitis-associated features on abdominal imaging were recorded using standardized case report forms. Data were collected from 518 patients (mean age, 52±14.6 years; 55% male; and 87.6% white). The most common physician-identified etiologies were alcohol (45.8%) and idiopathic (24.3%); 15.6% of patients reported no abdominal pain in the year before enrollment. The most common individual pain pattern was described as constant mild pain with episodes of severe pain, reported in 45% of patients. The most common imaging findings included pancreatic ductal dilatation (68%), atrophy (57%), and calcifications (55%). Imaging findings were categorized as obstructive for 20% and inflammatory for 25% of cases. The distribution of individual imaging findings was similar among patients with different patterns of pain. The distribution of pain patterns did not differ among clinically relevant groups of imaging findings. Mechanisms that determine patterns and severity of pain in patients with chronic pancreatitis are largely independent of structural variants observed by abdominal imaging techniques. Pancreas-relevant quantitative and qualitative pain measures should be included in the evaluation of patients with chronic pancreatitis, to assess pain severity independently of imaging findings.
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通讯作者：
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