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The natural history of pain in alcoholic chronic pancreatitis

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Presentation on theme: "The natural history of pain in alcoholic chronic pancreatitis"— Presentation transcript:

1 The natural history of pain in alcoholic chronic pancreatitis
Rudolf W. Ammann, Beat Muellhaupt  Gastroenterology  Volume 116, Issue 5, Pages (May 1999) DOI: /S (99) Copyright © 1999 American Gastroenterological Association Terms and Conditions

2 Fig. 1 Schematic representation of the two typical pain patterns in ACP. A-type pain pattern is characterized by short (usually ≤10 days) relapsing pain episodes separated by pain-free intervals of several months to ≥1 year. The intermittent pain episodes may either be severe, requiring hospitalization (H) (as is typical for acute pancreatitis), or mild and transient, manageable by the patient with short-term intake of nonnarcotic analgesics. B-type pain is characterized by prolonged periods of either persistent (daily) and/or clusters of recurrent severe pain exacerbations. Typically severe pain occurs 2 or more days per week for at least 2 months and requires repeated hospitalizations in most instances. Gastroenterology  , DOI: ( /S (99) ) Copyright © 1999 American Gastroenterological Association Terms and Conditions

3 Fig. 2 Cumulative rate of surgery in relation to onset of ACP. The first surgical procedure (□) for severe pain was necessary in 116 patients, mainly in early-stage ACP (in 75% ≤6 years after onset). A second procedure (■) for severe pain recurrences was necessary in 39 patients (34%) 5.5–7 years after the first procedure. Gastroenterology  , DOI: ( /S (99) ) Copyright © 1999 American Gastroenterological Association Terms and Conditions

4 Fig. 3 Probability of remaining free from pain recurrence for nonsurgical (––––) and surgical (....) patients. Gastroenterology  , DOI: ( /S (99) ) Copyright © 1999 American Gastroenterological Association Terms and Conditions

5 Fig. 4 Probability of remaining free of exocrine insufficiency for nonsurgical (––––) and surgical (....) patients. A fecal chymotrypsin value of >120 μg/g is indicative of normal exocrine function. Gastroenterology  , DOI: ( /S (99) ) Copyright © 1999 American Gastroenterological Association Terms and Conditions

6 Fig. 5 Probability of remaining free of diabetes mellitus for nonsurgical (––––) and surgical (....) patients. Gastroenterology  , DOI: ( /S (99) ) Copyright © 1999 American Gastroenterological Association Terms and Conditions

7 Fig. 6 Probability of remaining free of calcification for nonsurgical (––––) and surgical (....) patients. Gastroenterology  , DOI: ( /S (99) ) Copyright © 1999 American Gastroenterological Association Terms and Conditions

8 Fig. 7 Changes in body weight (in kg ± 95% confidence interval) from (A) onset to (D) final weight at the end of follow-up. An initial weight loss occurred in the early phase (A and B: P < in surgical and nonsurgical series), probably related to pain (B). A transient weight gain is noted in an intermediate phase, probably primarily due to arrest of pain (C) (B and C, P < in surgical and nonsurgical series). In advanced or end-stage ACP, a marked weight loss occurred, probably related to diabetes and/or steatorrhea (D) (C and D: P < in surgical and nonsurgical series). There was no significant difference in weight between the surgical and nonsurgical series at any stage of the disease. □, Nonsurgical; ●, surgical. Gastroenterology  , DOI: ( /S (99) ) Copyright © 1999 American Gastroenterological Association Terms and Conditions


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