AGA-ASGE 2013 Clinical Congress of Gastroenterology and Hepatology

New Research Is Changing the Clinical Perception of Chronic Pancreatitis

New information about the cause and treatment of chronic pancreatitis sheds light on old ways of thinking about the condition, according to Christopher Forsmark, MD, who addressed the subject this week during a joint conference of the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy in Coronado, California.
Researchers have identified several mutations of genes that could predispose someone to chronic pancreatitis. Chronic alcohol abuse is no longer considered the main culprit of the condition, particularly in women, but that news has not reached everyone in the business of health care, said Forsmark.
Patients are often still asked about their drinking habits when they seek treatment for symptoms. “They go to the ER, and the first thing the nurse says is, ‘How much do you drink?’ When they say, ‘I don’t drink,’ nobody believes them,” said Forsmark. “
While it is still an important contributing factor, alcohol consumption is now much less commonly identified as the cause of chronic pancreatitis. According to studies that tried to quantify how many daily alcoholic drinks would lead to the condition, the answer is “a lot,” said Forsmark, roughly five a day for five to 10 years.
Smoking is actually more potent than alcohol in causing pancreatitis. But the two together are very toxic, said Forsmark. Stopping smoking and/or drinking slows progression of the condition, improves pain, and reduces the chances of complications, he said.
While there are many new tests and techniques for assessing and diagnosing chronic pancreatitis, there has not been much progress in finding ways to identify the condition early in the clinical course, said Forsmark. One test he administers in his practice is a pancreatic function test with the hormone secretin, which he believes is better able to detect early disease.
Forsmark noted that a majority of patients who have acute pancreatitis don’t progress to chronic pancreatitis. Data suggest it will happen for about one in 10 patients, he said. For those who do progress, the process could take years and not everyone goes to the end of the spectrum.
“We end up with this group of patients who are somewhere in the middle,” on the road to chronic pancreatitis, said Forsmark.
In addressing treatment of pain associated with this condition, Forsmark said one of the big changes recently is the adoption of a different framework about why it occurs and persists. In the old days, the focus was on removing a stone or obstruction to alleviate the pain.
There is more evidence now that nerves in the pancreas play a significant role because they can become inflamed. “I think there is a lot of evidence now that it’s not just a plumbing problem. It’s a wiring problem,” said Forsmark.
This concept has gained traction in recent years and opens the door to possible new treatments, said Forsmark, who mentioned various types of present treatment options that include medications, endoscopic procedures, and surgery.

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