Painless chronic pancreatitis

Amodio, Antonio; Marchi, Giulia De; Pretis, Nicolò de; Crinò, Stefano Francesco; D’Onofrio, Mirko; Gabbrielli, Armando; Ciccocioppo, Rachele; Frulloni, Luca

doi:10.1016/j.dld.2020.08.040

Cited by 19 publications

(26 citation statements)

References 25 publications

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“…6,29 Interestingly, approximately 10% of patients with CP have no pain for reasons that are not yet understood. 30 The variability indicates unidentified intrinsic factors, such as genetic variants, psychiatric or other risk factors that affect the nature and severity of pain signaling since the imaging features of pancreatitis do not correlate with CP pain pattern or severity. 5…”

Section: Dovepressmentioning

confidence: 99%

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Dunbar¹,

Saloman²,

Phillips³

et al. 2021

JPR

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Pain is the most distressing and disruptive feature of recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) resulting in low quality of life (QOL) and disabilities. There is no single, characteristic pain pattern in patients with RAP and CP. Abdominal imaging features of CP accurately reflect morphologic features but they do not correlate with pain. Pain is the major driver of poor quality of life (QOL) and it is the constant pain, rather than intermittent pain that drives poor QOL. Furthermore, the most severe constant pain experience in CP is also a complex condition. The ability to target the etiopathogenesis of severe pain requires new methods to detect the exact pain mechanisms in an individual at cellular, tissue, system and psychiatric levels. In patients with complex and severe disease, it is likely that multiple overlapping mechanisms are simultaneously driving pain, anxiety and depression. Quantitative sensory testing (QST) shows promise in detecting alterations in central processing of pain signals and to classify patients for mechanistic and therapeutic studies. New genetic research suggests that genetic loci for severe pain in CP overlap with genetic loci for depression and other psychiatric disorders, providing additional insights and therapeutic targets for individual patients with severe CP pain. Well-designed clinical trials that integrate clinical features, QST, genetics and psychological assessments with targeted treatment and assessment of responses are required for a quantum leap forward. A better understanding of the context and mechanisms contributing to severe pain experiences in individual patients is predicted to lead to better therapies and quality of life.

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Section: Dovepressmentioning

confidence: 99%

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Dunbar¹,

Saloman²,

Phillips³

et al. 2021

JPR

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“…current pain, also consistent with prior clinical findings in cohorts of painless CP patients. 3,4 Experimental Pain Sensitivity…”

Section: Characteristics Of Painless Vs Painful Cpmentioning

confidence: 99%

“…This develops silently and is often either an incidental finding or is diagnosed in the workup of CP sequelae including exocrine pancreatic insufficiency or diabetes mellitus. 3,4 Such patients with painless CP typically have pancreatic morphology indistinguishable from that of those with painful CP, and therefore, other mediators of pain than those directly affecting the pancreatic gland must be of importance.…”

Section: Introductionmentioning

confidence: 99%

Pain Sensitivity and Psychiatric Comorbidities in Chronic Pancreatitis Patients With and Without Pain: Past Experience Matters

Phillips

Bick

Faghih

et al. 2022

Gastro Hep Advances

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“…Structural alterations are important to diagnose the disease but remain less helpful to identify patients who will develop complications or a severe course in a timely manner and are therefore candidates for intensive surveillance. Several questions are unanswered and need future investigation: What is the importance of the so-called painless chronic pancreatitis that usually occurs in elderly people 14,15 and often is underreported in such database studies? Moreover, different classifications of CP have to be evaluated in prospective studies to determine accuracy and predictive value for the development of exocrine and endocrine insufficiency.…”

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confidence: 99%

“Car body appearance and engine”: The morphology‐function correlation in chronic pancreatitis

Hollenbach

Capurso

2022

UEG Journal

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The morphology-function correlation in chronic pancreatitisChronic pancreatitis (CP) is a complex disease characterized by a continuous or recurrent inflammation of the pancreas 1 that results in progressive and irreversible morphologic alterations causing pain and impairment of pancreatic function. Typical findings are focal necrosis, fibrosis, enlarged and irregular pancreatic duct, intraductal stones and calcifications. 2,3 As such alterations more often occur in late CP, different classifications divide the disease in early and advanced stages based on structural findings (Cambridge, 4 Rosemont 5 ) and also etiology, symptoms and functionality (Manchester, 6 M-ANNHEIM 7 and others). The advantage of the Cambridge classification is the comparability of stage classification independent of the used imaging modality as Cambridge 0-4 was defined for endoscopic ultrasound, computed tomography or magnetic resonance imaging as well. However, none of the classifications published so far was prospectively evaluated to predict prognosis, course and complications of patients with CP. 8 In addition, several cohort studies failed to correlate in particular early morphological alterations and pancreatic insufficiency but found positive correlation in advanced stages of CP. 9In the current issue of UEG-Journal, Nordaas and colleagues 10 analyzed the association between structural alterations of patients with CP and complications, mainly endocrine and exocrine insufficiency. This was a cross-sectional analysis including more than 700 patients from the multicentric Scandinavian-Baltic-Pancreatic-Club database with CP classified by the M-ANNHEIM-criteria. In-and exclusion criteria as well as outcomes were clearly defined. In general, the authors found that a continuous organ involvement meaning structural abnormalities in the entire pancreas was associated with both pancreatic exocrine and endocrine insufficiency. Moreover, se-KEYWORDS

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Painless chronic pancreatitis

Cited by 19 publications

References 25 publications

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Pain Sensitivity and Psychiatric Comorbidities in Chronic Pancreatitis Patients With and Without Pain: Past Experience Matters

“Car body appearance and engine”: The morphology‐function correlation in chronic pancreatitis

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