Chronic pancreatitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]
Overview
The natural history of chronic pacreatitis is highly variable and mostly involves episodic abdominal pain that decreases or resolves over 5-25 years, while a few patients may have chronic pain. The risk of progression of chronic pancreatitis to pancreatic cancer is approximately 4% at 20 years. Common complications usually include pseudocyst formation and mechanical obstruction of the duodenum, and common bile duct. Less common complications may include pancreatic ascites, pleural effusion, pseudoaneurysm formation, and splenic vein thrombosis. Prognostic factors affecting patients suffering from chronic pancreatitis may include the age at diagnosis, smoking history, continued use of alcohol and, presence of liver cirrhosis. In chronic pancreatitis, the overall survival rate is 70% at 10 years and the 10-year mortality rate is 30%.
Natural History
- The natural history of chronic pancreatitis is highly variable and mostly involves episodic abdominal pain that decreases or resolves over 5-25 years, while a few patients may have chronic pain.
- The average duration from the onset of symptoms until the establishment of the diagnosis of chronic pancreatitis in alcoholics is 62 months and 81 months in non-alcoholics.
- In alcohol-induced pancreatitis, the pain severity may be reduced by cessation of alcohol intake.
- The risk of progression of chronic pancreatitis to pancreatic cancer is approximately 4% at 20 years.
Complications
- Diabetes[1]
- Pseudocysts
- Bile duct or duodenal obstruction
- Pancreatic ascites[2][3]
- Pleural effusion
- Splenic vein thrombosis[4][5][6]
- Pseudoaneurysm of splenic artery[7][8][9]
- Pancreatic cancer[10]
Prognosis
- Prognostic factors associated with chronic pancreatitis may include:
- The age at diagnosis
- Smoking
- Continued use of alcohol
- Presence of liver cirrhosis
- In chronic pancreatitis, the overall survival rate is 70% at 10 years.
- In chronic pancreatitis, the overall survival rate is 45% at 20 years.
- In chronic pancreatitis, the 10-year mortality rate is 30%.
- In chronic pancreatitis, the 20-year mortality rate is 55%.
References
- ↑ Rickels MR, Bellin M, Toledo FG, Robertson RP, Andersen DK, Chari ST, Brand R, Frulloni L, Anderson MA, Whitcomb DC (2013). "Detection, evaluation and treatment of diabetes mellitus in chronic pancreatitis: recommendations from PancreasFest 2012". Pancreatology. 13 (4): 336–42. doi:10.1016/j.pan.2013.05.002. PMC 3830751. PMID 23890130.
- ↑ Runyon BA (1987). "Amylase levels in ascitic fluid". J. Clin. Gastroenterol. 9 (2): 172–4. PMID 2437177.
- ↑ Gómez-Cerezo J, Barbado Cano A, Suárez I, Soto A, Ríos JJ, Vázquez JJ (2003). "Pancreatic ascites: study of therapeutic options by analysis of case reports and case series between the years 1975 and 2000". Am. J. Gastroenterol. 98 (3): 568–77. PMID 12650789.
- ↑ Forsmark CE, Wilcox CM, Grendell JH (1992). "Endoscopy-negative upper gastrointestinal bleeding in a patient with chronic pancreatitis". Gastroenterology. 102 (1): 320–9. PMID 1727767.
- ↑ Sakorafas GH, Sarr MG, Farley DR, Farnell MB (2000). "The significance of sinistral portal hypertension complicating chronic pancreatitis". Am. J. Surg. 179 (2): 129–33. PMID 10773149.
- ↑ Bernades P, Baetz A, Lévy P, Belghiti J, Menu Y, Fékété F (1992). "Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients". Dig. Dis. Sci. 37 (3): 340–6. PMID 1735356.
- ↑ Beattie GC, Hardman JG, Redhead D, Siriwardena AK (2003). "Evidence for a central role for selective mesenteric angiography in the management of the major vascular complications of pancreatitis". Am. J. Surg. 185 (2): 96–102. PMID 12559436.
- ↑ Arnaud JP, Bergamaschi R, Serra-Maudet V, Casa C (1994). "Pancreatoduodenectomy for hemosuccus pancreaticus in silent chronic pancreatitis". Arch Surg. 129 (3): 333–4. PMID 8129612.
- ↑ Wagner WH, Cossman DV, Treiman RL, Foran RF, Levin PM, Cohen JL (1994). "Hemosuccus pancreaticus from intraductal rupture of a primary splenic artery aneurysm". J. Vasc. Surg. 19 (1): 158–64. PMID 8301728.
- ↑ Lowenfels AB, Maisonneuve P, DiMagno EP, Elitsur Y, Gates LK, Perrault J, Whitcomb DC (1997). "Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group". J. Natl. Cancer Inst. 89 (6): 442–6. PMID 9091646.