Structural imaging findings are related to clinical complications in chronic pancreatitis

Abstract

Background/objectives Structural pancreatic changes and complications related to chronic pancreatitis are well described, but little is known about their relationship. We aimed to explore the associations between pancreatic morphology and clinical complications in a large chronic pancreatitis cohort. Methods The Scandinavian Baltic Pancreatic Club database collects registrations on patients with definite or probable chronic pancreatitis according to the M‐ANNHEIM diagnostic criteria. In this cross‐sectional study, we used multivariate logistic regression analyses to evaluate whether imaging‐based structural pancreatic changes were associated with common clinical complications. We adjusted for sex, age, disease duration, current alcohol abuse and current smoking. Results We included 742 patients with a mean age of 55 years. Among these, 68% were males, 69% had pancreatic exocrine insufficiency, 35% had diabetes, 12% were underweighted and 68% reported abdominal pain. Main pancreatic duct obstruction, severe (i.e. more than 14) calcifications, pancreatic atrophy and parenchymal changes throughout the entire pancreas (continuous organ involvement) were positively associated with pancreatic exocrine insufficiency. Continuous organ involvement and pseudocysts were positively and negatively associated with diabetes, respectively. Pancreatic atrophy and severe calcifications were positively associated with underweight, and severe calcifications were negatively associated with pain. Conclusions This study shows independent associations between distinct structural changes on pancreatic imaging and clinical complications in chronic pancreatitis. Pancreatic atrophy, severe calcifications and continuous organ involvement may be of particular clinical relevance, and these findings should motivate monitoring of pancreatic function and nutritional status.

Technical features of Frey's operation in patients with complicated forms of chronic pancreatitis

“…Завдяки еволюції хірургічної техніки при ХП операція Фрея, де використовується гібридна природа, стала затребуваним хірургічним втручанням із значним зменшенням болю та низьким рівнем інтраопераційних ускладнень [6; 7]. Досягнення в стратегіях лікування ХП із застосуванням органозберігаючих хірургічних методів дозволили поліпшити результати у пацієнтів, які перенесли операції на ПЗ [8], так як при виборі методу операції виникала необхідність з одного боку максимального збереження тканини ПЗ з іншого -радикального усунення морфологічних змін, що створювало передумови стабілізації прогресування патології [9]. Виконання втручань до виникнення грубих морфологічних змін у ПЗ є досить важливим та обґрунтованим.…”

Clinical and translational markers of severity and prognosis in chronic pancreatitis

“…Biomarkers routinely used in severity assessment during chronic pancreatitis management are faecal elastase 1 and HbA1c, as markers of exocrine and endocrine pancreatic function, and 25-OH-vitamin D, calcium, albumin and phosphate to assess nutritional failure and risk for osteopenia [25,26]. In terms of biomarker-based prediction of whether a patient will develop chronic pancreatitis, the difficulty in particular for the early stages of chronic pancreatitis is that, unlike late disease stages with clear disease-specific organ manifestations (calcifications and duct distortion), the underlying pathophysiological mechanisms that distinguish health from disease are not yet well understood [1,27]. This is further complicated by the fact that for the early stage of chronic pancreatitis no clearly defined clinicopathological symptom complex could be consented in expert panels so far [28].…”

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

“…In 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.…”