Chronic pancreatitis: pathogenesis and management of pain.

Abstract:

:Abdominal pain, excruciating and recurrent, is the dominant feature of chronic pancreatitis that initially brings most of the patients to the physician's attention. The pathogenesis of pancreatic pain is often multifactorial and explains why not all patients respond to the same mode of therapy. Increased intraductal pressure as a result of ductal stricture and/or calculi is the most frequent cause for pain in the large majority of patients with large duct disease. Interstitial hypertension, ongoing pancreatic ischemia, neuronal inflammation, and extra pancreatic complications may be the sole or additional factors in the pathogenesis of pain. The management of pain is difficult and requires a team approach. Internist, gastroenterologist, radiologist, surgeon, and a psychiatrist may have to work together to achieve maximum success. Drug and alcohol dependency needs vigorous management by a psychiatrist. Supportive therapy with a low-fat diet and antioxidant supplementation are helpful. When analgesic therapy fails, surgery may have to be considered much before a narcotic dependency develops. If at all of use, oral pancreatic enzyme therapy is suitable only in a selected group of patients--women with idiopathic pancreatitis. Endoscopic papillotomy, stent placement, and stone removal, although becoming popular, are under trial only and appear to be suitable in those with obstructive disease mostly localized to the head of the pancreas without much proximal disease. A patient with a dilated duct system is a good candidate for Puestow's pancreatico-jejunal anastamosis, which appears to be the best surgical procedure. Those with small duct diseases are difficult to be managed. Resective procedures and celiac ganglion blocking are suggested but not of much help.

journal_name

J Clin Gastroenterol

authors

Pitchumoni CS

doi

10.1097/00004836-199809000-00002

subject

Has Abstract

pub_date

1998-09-01 00:00:00

pages

101-7

issue

2

eissn

0192-0790

issn

1539-2031

journal_volume

27

pub_type

杂志文章,评审
  • Development of Image-enhanced Endoscopy of the Gastrointestinal Tract: A Review of History and Current Evidences.

    abstract::Endoscopy imaging of the gastrointestinal (GI) tract has evolved tremendously over the last few decades. Key milestones in the development of endoscopy imaging include the use of various dyes for chromoendoscopy, the application of optical magnification in endoscopy, the introduction of high-definition image capturing...

    journal_title:Journal of clinical gastroenterology

    pub_type: 历史文章,杂志文章

    doi:10.1097/MCG.0000000000000960

    authors: Ho SH,Uedo N,Aso A,Shimizu S,Saito Y,Yao K,Goh KL

    更新日期:2018-04-01 00:00:00

  • Evaluation of the Esophagogastric Junction on High Resolution Manometry.

    abstract::The esophagogastric junction (EGJ) is a complex barrier between the thoracic and abdominal luminal gut compartments, comprised primarily of the lower esophageal sphincter (LES) and crural diaphragm. Although closed at rest, the EGJ relaxes to allow antegrade bolus transit and retrograde venting of air. Abnormal relaxa...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/MCG.0000000000001474

    authors: Rogers BD,Gyawali CP

    更新日期:2021-02-01 00:00:00

  • CapsoCam SV-1 Versus PillCam SB 3 in the Detection of Obscure Gastrointestinal Bleeding: Results of a Prospective Randomized Comparative Multicenter Study.

    abstract:BACKGROUND AND STUDY AIM:Newer capsule with a panoramic viewing mode is available and might increase the detection rate of bleeding lesions in patients with obscure gastrointestinal bleeding (OGIB). Furthermore, an improved patient acceptance rate is expected. MATERIALS AND METHODS:In a randomized prospective comparat...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1097/MCG.0000000000000994

    authors: Zwinger LL,Siegmund B,Stroux A,Adler A,Veltzke-Schlieker W,Wentrup R,Jürgensen C,Wiedenmann B,Wiedbrauck F,Hollerbach S,Liceni T,Bojarski C

    更新日期:2019-03-01 00:00:00

  • Ultrasonography-guided percutaneous radiofrequency ablation for treatment of a huge symptomatic hepatic cavernous hemangioma.

    abstract::Hepatic cavernous hemangioma is the most common benign tumor of the liver. Appropriate management of this tumor remains a controversial topic. We have accumulated a number of cases with successful management of local hepatic tumors. Here we report a case where we performed an ultrasound-guided percutaneous radiofreque...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/01.mcg.0000196404.07487.1d

    authors: Tak WY,Park SY,Jeon SW,Cho CM,Kweon YO,Kim SK,Choi YH,Chung JM

    更新日期:2006-02-01 00:00:00

  • Pathophysiology of Nonalcoholic Steatohepatitis.

    abstract::Nonalcoholic fatty liver disease (NAFLD) affects approximately 30% of adults and 20% of children in the United States. Nonalcoholic steatohepatitis (NASH) is its most severe histologic form and progresses to cirrhosis in 20% of these patients. Once developed, 30% to 40% of patients with NASH cirrhosis will experience ...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/01.mcg.0000168645.86658.22

    authors: McCullough AJ

    更新日期:2006-03-01 00:00:00

  • Utility and standards in esophageal manometry.

    abstract::Esophageal manometry is a specialized procedure used to evaluate lower and upper esophageal sphincter pressure, esophageal body contraction amplitude, and peristaltic sequence. The procedure is clinically useful in evaluation of a patient with nonstructural dysphagia, unexplained or noncardiac chest pain, a compendium...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章,评审

    doi:10.1097/MCG.0b013e3181653a5c

    authors: Katz PO,Menin RA,Gideon RM

    更新日期:2008-05-01 00:00:00

  • Endoscopic ultrasonography in multiple lymphomatous polyposis.

    abstract::Two cases of multiple lymphomatous polyposis (MLP) are presented, involving different segments of the gastrointestinal tract. Both cases display the characteristic clinical and pathologic features of MLP. In addition, we were able to document, for the first time, the endoscopic ultrasonographic findings in this diseas...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-200202000-00010

    authors: Viana HL,Henrique RM,Ferreira ES,Correia AM,Silva RA,Dias LM,Viana RL

    更新日期:2002-02-01 00:00:00

  • Predictors of Mortality in Cirrhosis Inpatients With Clostridium difficile Infection.

    abstract:BACKGROUND:Clostridium difficile is a bacterial pathogen associated with significant morbidity and mortality in patients with cirrhosis. GOALS:Our primary aim is to identify variables that are predictive of poor outcomes in cirrhosis patients with C. difficile infection (CDI). We also aim to further characterize the r...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/MCG.0000000000000868

    authors: Smith EZ,Northup PG,Argo CK

    更新日期:2018-09-01 00:00:00

  • Multiple lymphomatous polyposis of the gut.

    abstract::Multiple lymphomatous polyposis is very rare. We report two cases affecting duodenum, small intestine and colon/rectum, both with extensive disease, making radical surgery impossible and chemotherapy the treatment of choice. One patient died 23 days after initial treatment of myocardial infiltration, and the other is ...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-199409000-00012

    authors: Norum J,Hovde O,Stalsberg H

    更新日期:1994-09-01 00:00:00

  • Perforation of small intestine caused by Churg-Strauss syndrome.

    abstract::In Churug-Strauss Syndrome (CSS), gastrointestinal tract (GIT) is an uncommon site of involvement. In addition to review of recent literature, we herein report a case of CSS with unusual involvement of GIT. The patient was being treated for idiopathic hypereosinophilic syndrome for 2 years; he later developed acute pe...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-199610000-00017

    authors: Sharma MC,Safaya R,Sidhu BS

    更新日期:1996-10-01 00:00:00

  • Relatively low expression of multidrug resistance-1 (MDR-1) and its possible clinical implication in gastric cancers.

    abstract::The mechanism of drug resistance of gastric cancer cells has rarely been investigated. We specifically examine the magnitude and the biologic significance of multidrug resistance-1 (MDR-1) expression in human gastric cancer. All patients had previously been treated in prospective clinical trials for advanced gastric c...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-199806000-00012

    authors: Yeh KH,Chen CL,Shun CT,Lin JT,Lee WJ,Lee PH,Chen YC,Cheng AL

    更新日期:1998-06-01 00:00:00

  • Risk Factors and Outcomes of Reversal Agent Use in Moderate Sedation During Endoscopy and Colonoscopy.

    abstract:BACKGROUND:Moderate sedation has been standard for noninvasive gastrointestinal procedures for decades yet there are limited data on reversal agent use and outcomes associated with need for reversal of sedation. AIM:To determine prevalence and clinical significance of reversal agent use during endoscopies and colonosc...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/MCG.0000000000000291

    authors: Hung A,Marshall J,Barnett S,Falchuk ZM,Sawhney M,Leffler DA

    更新日期:2016-03-01 00:00:00

  • Occult carcinoma of the breast masquerading as primary adenocarcinoma of the small intestine. A case report.

    abstract::A fifty-year-old woman with abdominal pain, diarrhea, and weight loss ultimately required exploratory laparotomy. The entire small intestine was extensively infiltrated by poorly differentiated adenocarcinoma; mesenteric lymph nodes and surrounding omentum were involved, but no extragastrointestinal tumor was found. A...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-198804000-00023

    authors: Hansen RM,Lewis JD,Janjan NA,Komorowski RA

    更新日期:1988-04-01 00:00:00

  • Antimitochondrial antibody-negative chronic nonsuppurative destructive cholangitis. Atypical primary biliary cirrhosis or autoimmune cholangitis?

    abstract::We investigated whether autoimmune cholangitis (AC) has specific features that constitute an entity other than primary biliary cirrhosis (PBC). We compared clinical, laboratory, and liver biopsy features; response to treatment; and the follow-up of two groups of patients. The first group comprised seven patients with ...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-199610000-00007

    authors: Sánchez-Pobre P,Castellano G,Colina F,Dominguez P,Rodriguez S,Canga F,Herruzo JA

    更新日期:1996-10-01 00:00:00

  • Motility of the transverse colon used for esophageal replacement.

    abstract::The authors studied the motility of transverse colon used for reconstruction of the pharyngogastric transit after esophagectomy. The study included 10 patients who underwent esophagectomy 15 to 201 months (median, 48.5 months) before motility evaluation. Nine patients underwent operation because of caustic injury and ...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-200203000-00005

    authors: Dantas RO,Mamede RC

    更新日期:2002-03-01 00:00:00

  • Mechanisms of gastric mucosal injury and protection.

    abstract::This article emphasizes and reviews the premise that because the pathogenesis of acute gastric mucosal injury is multifactorial, several protective mechanisms should also be considered in analyzing gastric mucosal defense. The first part of the article reviews the pathogenesis of acute gastric mucosal injury by major ...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章,评审

    doi:

    authors: Szabo S

    更新日期:1991-01-01 00:00:00

  • Histologic findings and Helicobacter pylori in duodenal biopsies.

    abstract::We have studied the morphologic aspects of the duodenal bulb in relation to Helicobacter pylori infection in a large group of patients with endoscopically assessed duodenitis to learn more about the pathogenesis of nonspecific duodenitis (bulbitis) and to clarify the specific role of H. pylori. Eight duodenal biopsy s...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-199801000-00020

    authors: Caselli M,Gaudio M,Chiamenti CM,Trevisani L,Sartori S,Saragoni L,Boldrini P,Dentale A,Ruina M,Alvisi V

    更新日期:1998-01-01 00:00:00

  • Microbiota, innate immune system, and gastrointestinal muscle: ongoing studies.

    abstract:AIM:To test the activities of culture-extracted or commercially available toll-like receptors (TLRs) ligands to establish their direct impact on target gastrointestinal motor cells. METHODS:Short-term and long-term effects of Shigella flexneri M90T and Escherichia coli K-2 strains-extracted lipopolysaccharides (LPS), ...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/MCG.0b013e318265ea7d

    authors: Tattoli I,Petitta C,Scirocco A,Ammoscato F,Cicenia A,Severi C

    更新日期:2012-10-01 00:00:00

  • Primary choledochoduodenostomy for benign obstructive biliary tract disease.

    abstract::Repeated surgical interventions on the biliary ductal system increase morbidity and mortality, particularly in the geriatric patient. In an attempt to prevent these complications, side-to-side choledochoduodenostomy was performed as the primary operative procedure in 54 patients, age 72 +/- 13 years. This was the pati...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-199008000-00013

    authors: Berlatzky Y,Freund HR

    更新日期:1990-08-01 00:00:00

  • Fermentation in the human large intestine: its physiologic consequences and the potential contribution of prebiotics.

    abstract::The human large intestine harbors a complex microbiota containing many hundreds of different bacterial species. Although structure/function relationships between different components of the microbiota are unclear, this complex multicellular entity plays an important role in maintaining homeostasis in the body. Many of...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章,评审

    doi:10.1097/MCG.0b013e31822fecfe

    authors: Macfarlane GT,Macfarlane S

    更新日期:2011-11-01 00:00:00

  • Same-day Versus Split-dose Bowel Preparation Before Colonoscopy: A Meta-analysis.

    abstract:BACKGROUND:Split-dose regimens (SpDs) were recommended as a first choice for bowel preparation, whereas same-day regimens (SaDs) were recommended as an alternative; however, randomized trials compared them with mixed results. The meta-analysis was aimed at clarifying efficacy level between the 2 regimens. MATERIALS AN...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章,meta分析

    doi:10.1097/MCG.0000000000000860

    authors: Cheng YL,Huang KW,Liao WC,Luo JC,Lan KH,Su CW,Wang YJ,Hou MC

    更新日期:2018-05-01 00:00:00

  • Biliary tract obstruction secondary to mycosis fungoides: a case report.

    abstract::Mycosis fungoides is a cutaneous T-cell lymphoma that can disseminate to multiple organs. We report a patient who presented with obstructive jaundice caused by isolated involvement of the extrahepatic biliary tree by mycosis fungoides. Initially, endoscopic examinations and biopsies of the biliary tree and liver faile...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-199901000-00015

    authors: Madsen JA,Tallini G,Glusac EJ,Salem RR,Braverman I,Robert ME

    更新日期:1999-01-01 00:00:00

  • Management of Chronic Hepatitis B in Pregnancy.

    abstract::Chronic hepatitis B virus (HBV) infection due to mother-to-child transmission during the perinatal period remains an important global health problem. Despite standard passive-active immunoprophylaxis with hepatitis B immunoglobulin and hepatitis B vaccine in neonates, up to 8.5% of newborns still acquire HBV infection...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章,评审

    doi:10.1097/MCG.0000000000000908

    authors: Li J,Chang MS,Tran TT,Nguyen MH

    更新日期:2017-10-01 00:00:00

  • No decrease in duodenal ulcer surgery after cimetidine in Hong Kong.

    abstract::We undertook a 12-year review of the elective and emergency surgery for duodenal ulcer in Queen Mary Hospital, Hong Kong, to ascertain whether the introduction of cimetidine as treatment for duodenal ulcer had led to a reduction in the number of elective and emergency operations being performed for duodenal ulcer. The...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-198802000-00007

    authors: Alagaratnam TT,Wong J

    更新日期:1988-02-01 00:00:00

  • Serum hepatitis C virus titers in the progression of type C chronic liver disease. With special emphasis on patients with type 1b infection.

    abstract::The correlation of serum hepatitis C virus (HCV) titers to the progression of type C chronic liver disease remains controversial. We have investigated the relationship between serum HCV titers and different histological stages of chronic liver disease, including chronic persistent hepatitis (CPH), chronic active hepat...

    journal_title:Journal of clinical gastroenterology

    pub_type: 临床试验,杂志文章

    doi:10.1097/00004836-199612000-00008

    authors: Kao JH,Lai MY,Chen PJ,Hwang LH,Chen DS

    更新日期:1996-12-01 00:00:00

  • Endoscopy in the evaluation of patients with upper gastrointestinal symptoms: indications, expectations, and interpretation.

    abstract::Upper gastrointestinal endoscopy is the most sensitive diagnostic test in patients with upper gastrointestinal symptoms. Endoscopy performed by trained examiners, however, still misses lesions. Single-contrast upper gastrointestinal x-ray adds little new information to a complete endoscopic examination by a trained en...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:

    authors: Tedesco FJ

    更新日期:1981-01-01 00:00:00

  • Cisapride versus placebo in reflux esophagitis. A multicenter double-blind trial.

    abstract::In a 6 to 12-week double-blind trial, the effect of cisapride (10 mg q.i.d.) was compared with that of placebo in 63 patients with esophagitis confirmed by endoscopy and/or biopsy. In only one patient (3%) in the cisapride group but in 43% of the placebo patients (p = 0.001), symptoms had not improved after 6 weeks. F...

    journal_title:Journal of clinical gastroenterology

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1097/00004836-198812000-00007

    authors: Baldi F,Bianchi Porro G,Dobrilla G,Iascone C,Lobello R,Marzio L,Sabbatini F,Tittobello A,Verme G

    更新日期:1988-12-01 00:00:00

  • Of mice and men: lessons on Crohn's disease and the spirit of scientific inquiry.

    abstract::Over the past 10 years, Kiron Das and his associates have developed an animal model for the study of a putative Crohn's disease (CD)-specific antigen. Athymic T-cell deficient nu/nu mice inoculated with intestinal and lymph node tissue filtrates from patients with CD sometimes develop lymphomas and/or lymph node plasm...

    journal_title:Journal of clinical gastroenterology

    pub_type: 评论,杂志文章

    doi:

    authors: Sachar DB

    更新日期:1989-12-01 00:00:00

  • Infection with hepatitis C virus genotype 4 in the United States.

    abstract:BACKGROUND:Hepatitis C virus genotype differences seem to be of considerable clinical significance because they affect responses to antiviral therapy. HCV genotype 4 is rare in the United States and there are few published data regarding response to therapy in patients with HCV genotype 4 infection. OBJECTIVES:To asse...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章

    doi:10.1097/00004836-200401000-00014

    authors: Lyra AC,Ramrakhiani S,Bacon BR,Di Bisceglie AM

    更新日期:2004-01-01 00:00:00

  • Celecoxib Monotherapy Maintained Small Intestinal Mucosa Better Compared With Loxoprofen Plus Lansoprazole Treatment: A Double-blind, Randomized, Controlled Trial.

    abstract:GOALS:The aim of this study was to compare celecoxib with loxoprofen for protection of small intestine. BACKGROUND:RCT studies report that COX-2 selective inhibitor celecoxib induces fewer small intestinal injuries than nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). Loxoprofen is a prodrug nonselective NS...

    journal_title:Journal of clinical gastroenterology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/MCG.0000000000000372

    authors: Fujimori S,Hanada R,Hayashida M,Sakurai T,Ikushima I,Sakamoto C

    更新日期:2016-03-01 00:00:00