Recommendations from the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis

Domínguez‐Muñoz, Enrique; Lindkvist, Björn; Ewald, Nils; Czakó, László; Rosendahl, Jonas; Löhr, Matthias; Besselink, Marc G.; Mayerle, Julia; Lerch, Markus M.; Akisik, Fatih; Kartalis, Nikolaos; Manfredi, Riccardo; Iglesias‐García, Julio; Haas, Stephan; Keller, Jutta; Boermeester, Marja A.; Werner, Jens; Dumonceau, Jean‐Marc; Fockens, Paul; Drewes, Asbjørn Mohr; Cheyan, Güralp O.; Drenth, Joost P.H.; Hardt, Philip D.; de-Madaria, Enriqué; Gheorghe, C.; Lindgren, Fredrik; Schneider, Alexander; Witt, Heiko; Bollen, Thomas L.; Boraschi, Piero; Frøkjær, Jens Brøndum; Rudolf, Saša; Bruno, Marco J.; Dimcevski, Georg; Giovannini, Marc; Puķītis, Aldis; Petrone, M.C.; Oppong, Kofi; Ammori, Basil; Frieß, Helmut; Izbiki, J.R.; Ganeh, Paula; Salvia, Roberto; Sauvanet, Alain; Barbu, Sorin T.; Lyadov, Vladimir; Deprez, Pierre Henri; Губергриц, Н. Б.; Okhlobystiy, Alexey V.; Arvanitakis, Marianna; Costamagna, Guido; Pap, Ákos; Andersson, Roland; Hauge, Truls; McKay, Colin; Pukitis, Aldos; Regnér, Sara; Dite, Peter; Olesen, Søren Schou; Duggan, Sinead N.; Hopper, Andrew D; Phillips, Mary; Shvets, Oleg; Vujasinović, Miroslav; Piemonti, Lorenzo; Kocher, Hemant M.; Rebours, Vinciane; Štimac, Davor; Hegyi, Péter

doi:10.1016/j.pan.2018.09.016

Cited by 122 publications

(98 citation statements)

References 16 publications

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“…Computed tomography (CT) remains the best initial imaging modality to diagnose CP, with the findings of pancreatic duct dilatation, pancreatic atrophy, pancreatic mass, calcification and/or recurrent pseudocyst formation [11]. However, normal pancreatic morphology may also be observed on CT imaging with early CP, making diagnosis particularly challenging.…”

Section: Diagnosis and Classification Of Chronic Pancreatitismentioning

confidence: 99%

The role of surgery in chronic pancreatitis

et al. 2019

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Background Chronic pancreatitis (CP) remains a complex condition resulting in significant morbidity and suffering in patients, often over a long period of time. Treatment is mostly centred on a conservative approach, with a variety of more aggressive options being trialled over the years utilising numerous endoscopic and surgical techniques. Methods This review provides an overview of current treatment options for CP, the literature search was performed via PubMed. Personal experiences from the authors on how to approach the disease from the surgeon's perspective are added. The outline includes pathophysiologic aspects, classifications and patientcentred surgical approaches. Results There has not been a standardized treatment for CP so far as clinical and radiological appearance of the disease have a wide range due to great heterogeneity of this complex disease; therefore, level 1 evidence for treatment of CP remains low. More recently, different approaches to surgical management have been trialled. With personalized surgery, long-term pain relief is achievable in up to 90% with low morbidity. Autologous islet cell transplantation is a feasible option in selected patients to avoid endocrine insufficiency. Conclusion A tailored approach to CP patients is mandatory in this heterogeneous disease. Surgery provides good outcomes especially as prophylaxis for and treatment of chronic pain. A multidisciplinary approach is mandatory, including physicians, pancreatic surgeons, endoscopists, dieticians and radiologists.

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Section: Diagnosis and Classification Of Chronic Pancreatitismentioning

confidence: 99%

The role of surgery in chronic pancreatitis

et al. 2019

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“…Also they classify patients with exocrine insufficiency as severe or end-stage, and it has become apparent that exocrine dysfunction can occur much earlier in the course of CP than previously considered, in particular in patients in whom CP develops following acute severe AP [65,66]. Furthermore, these systems do not account for the clinically important sequelae of mild or moderate pancreatic exocrine insufficiency, such as fat-soluble vitamin malabsorption and osteopathy [6]. The M-ANNHEIM system appears to be the most comprehensive tool available.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…To improve the clinical management of CP and reflect up to date advances in the understanding of aetiological and functional sequelae, a classification system based on the key clinical aspects such as pain, pancreatic functional status (exocrine and endocrine), and imaging modalities are desirable [6,73]. An effective scoring system would be able to classify and characterise all presentations of CP complications across relevant categories of pain, function (including endocrine function, exocrine function, nutritional status, and bone health) and mechanical (including pancreatic and extra-pancreatic complications) while incorporating explicit aetiological and diagnostic classifications.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…It is characterised by abdominal pain, irreversible pancreatic morphological changes, loss of exocrine and endocrine pancreatic function, nutritional and mechanical complications [1][2][3][4][5]. The overall incidence of CP in Europe is 5-10 per 100,000, and there are data to suggest that the incidence is increasing [6][7][8]. Whilst the majority of cases from western countries have been attributed to alcohol excess, it is now recognised to have a multifactorial aetiology [9].…”

Section: Introductionmentioning

confidence: 99%

“…Recently published evidence-based guidelines from the working group on "Harmonising diagnosis and treatment of CP across Europe" noted that there is no "preferred classification system for defining the aetiology of CP since the available classification systems need to be evaluated in randomised prospective trials" [6]. Contemporary clinical practice updates from North America also have not incorporated the use of clinical classification systems [13].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Classification and Severity Scoring Systems in Chronic Pancreatitis: A Systematic Review

et al. 2019

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Introduction: Chronic pancreatitis (CP) is characterised by pain, functional deficits, nutritional and mechanical complications. Frequently managed in out-patient settings, the clinical course is unpredictable and requires multi-disciplinary care. There remains substantial variation in management. In contrast to acute pancreatitis, there are no globally accepted classification or severity scores to predict the disease course or compare interventions. We conducted a systematic review to determine the scope and clinical use of existing scoring systems. Methods: A systematic search was developed with a medical librarian using the Embase, Medline and Cochrane databases. Original articles and conference abstracts describing an original or modified classification or scoring system in CP that stratified patients into clinical and/or severity categories were included. To assess clinical application/validation, studies using all or part of a score as a stratification tool to measure another parameter or outcome were selected. Studies reporting on diagnosis or aetiology only were excluded. Four authors performed the search in independent pairs and conflicts were resolved by a fifth author using Covidence TM systematic review software. Results: Following screening 6,652 titles and 235 full-text reviews, 48 papers were analysed. Eleven described original scores and 6 described modifications of published scores. Many were comprehensive but limited in capturing the full spectrum of disease. In 31 studies, a score was used to categorise patients to compare or correlate various outcome measures. Exocrine and endocrine dysfunction and pain were included in 6, 5, and 4 scoring systems, respectively. No score included other nutrition parameters, such as bone health, malnutrition, or nutrient deficiency. Only one score has been objectively validated prospectively and independently for monitoring clinical progression and prognosis, but this had been applied to an in-patient population. Conclusion: Available systems and scores do not reflect recent A.R. and D.B.O.C. contributed equally to the manuscript. Rahman et al.advances and guidelines in CP and are not commonly used. A practical clinical classification and scoring system, validated prospectively for prognostication would be useful for the meaningful analysis in observational and interventional studies in CP.

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Diagnosis and Management of Chronic Pancreatitis

Singh

Yadav

Garg

2019

JAMA

271

178

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hronic pancreatitis (CP) is a chronic progressive disease with an annual incidence of 5 to 8 and prevalence of 42 to 73 cases per 100 000 adults in the United States. 1-3 Prevalence rates varying from 36 to 125 per 100 000 population have been reported from Japan, China, and India, of which India has the highest prevalence. 4,5 Chronic pancreatitis is characterized by fibrosis and inflammation of the pancreas in individuals with genetic, environmental, and other risk factors such as hypertriglyceridemia. Chronic pancreatitis is characterized by pancreatic atrophy, fibrosis, ductal strictures and distortion, calcifications, dysplasia, exocrine insufficiency and diabetes, and chronic pain. 6 This review summarizes current evidence regarding risk factors, pathophysiology, clinical features, diagnostic evaluation, treatment, and prognosis of CP. MethodsWe searched PubMed for relevant English-language articles published from January 1, 2000, to July 1, 2019. Search terms included chronic pancreatitis and each of the following:

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Recommendations from the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis

Cited by 122 publications

References 16 publications

The role of surgery in chronic pancreatitis

The role of surgery in chronic pancreatitis

Clinical Classification and Severity Scoring Systems in Chronic Pancreatitis: A Systematic Review

Diagnosis and Management of Chronic Pancreatitis

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