RESUMO
BACKGROUND/OBJECTIVES: Chronic pancreatitis (CP) is a progressive inflammatory disorder associated with marked morbidity and mortality and frequently requires hospitalization. This study aimed to investigate the time trends and geographical distribution of hospital admissions, the lethality rate of CP across Brazil, and the potential relationship with social indicators and associated risk factors. METHODS: Data were retrospectively obtained from the Brazilian Public Health System Registry between January 2009 and December 2019. The prevalence and lethality rates of CP per 100,000 inhabitants in each municipality were estimated from hospitalizations to in-hospital deaths and classified by age, sex, and demographic features. RESULTS: During the study period, 64,609 admissions were retrieved, and most of the patients were males (63.54%). Hospitalization decreased by nearly half (-54.68%) in both sexes. CP rates in males were higher in all age groups. The greatest reduction in admissions (- 64%) was also noted in patients ≥ 70y. CP In-hospital lethality remained stable (5-6%) and similar for males and females. Patients ≥ 70y showed the highest lethality. The greatest increase in CP lethality rates (+ 10%) was observed in municipalities integrated into metropolises, which was mainly driven by small-sized municipalities (+ 124%). CONCLUSIONS: CP hospitalizations decrease in both urban and rural areas, particularly in the North, Northeast, and Central-West regions, and in those above 70 years of age, but are not correlated with lethality rates in the South. This suggests ongoing changes in the environmental and socioeconomic factors in Brazil.
Assuntos
Hospitalização , Pancreatite Crônica , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Pancreatite Crônica/epidemiologia , Pancreatite Crônica/mortalidade , Pancreatite Crônica/terapia , Adulto , Idoso , Brasil/epidemiologia , Estudos Retrospectivos , Hospitalização/tendências , Hospitalização/estatística & dados numéricos , Adulto Jovem , Fatores de Risco , Mortalidade Hospitalar/tendências , Países em Desenvolvimento/estatística & dados numéricos , Prevalência , AdolescenteRESUMO
ABSTRACT: There exists no cure for acute, recurrent acute or chronic pancreatitis and treatments to date have been focused on managing symptoms. A recent workshop held by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) focused on interventions that might disrupt or perhaps even reverse the natural course of this heterogenous disease, aiming to identify knowledge gaps and research opportunities that might inform future funding initiatives for NIDDK. The breadth and variety of identified active or planned clinical trials traverses the spectrum of the disease and was conceptually grouped for the workshop into behavioral, nutritional, pharmacologic and biologic, and mechanical interventions. Cognitive and other behavioral therapies are proven interventions for pain and addiction, but barriers exist to their use. Whilst a disease specific instrument quantifying pain is now validated, an equivalent is lacking for nutrition - and both face challenges in ease and frequency of administration. Multiple pharmacologic agents hold promise. Ongoing development of Patient Reported Outcome (PRO) measurements can satisfy Investigative New Drug (IND) regulatory assessments. Despite multiple randomized clinical trials demonstrating benefit, great uncertainty remains regarding patient selection, timing of intervention, and type of mechanical intervention (endoscopic versus surgery). Challenges and opportunities to establish beneficial interventions for patients were identified.
Assuntos
Diabetes Mellitus , Pancreatite Crônica , Humanos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , National Institute of Diabetes and Digestive and Kidney Diseases (U.S.) , Dor , Pancreatite Crônica/terapia , Pancreatite Crônica/tratamento farmacológico , Estados UnidosRESUMO
BACKGROUND: Alcohol and tobacco are important risk factors for chronic pancreatitis (CP). AIM: To analyze the effect of etiological factors such as tobacco and alcohol and pancreatic enzyme replacement therapy (PERT) in the progression of CP. MATERIAL AND METHODS: Patients with a diagnosis of CP were recruited and grouped according to variables such as tobacco, alcohol and PERT. They were followed for 18 months. Subsequently, different variables and analytical parameters involved in the progression of the disease were analyzed. RESULTS: A total of 50 patients diagnosed with CP were included. Of these, 28 patients underwent PERT, 39 were smokers and 33 were alcohol users. Compared with patients without PERT, those with PERT had a higher proportion of diabetes (64 and 32%, respectively), had a higher need for endoscopic treatment (25 and 0%, respectively) and a normal body mass index (71 and 27.3%, respectively. The smokers had higher calcium levels and increased lymphocytosis and leukocytosis. The alcohol consumption group had a higher mean age (p = 0.04) CONCLUSIONS: PERT may improve the nutritional status but does not reduce the need for endoscopic or surgical treatment. Smoking and alcohol consumption favored the progression of CP. Also, smoking induced a pro-inflammatory state.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pancreatite Crônica/etiologia , Pancreatite Crônica/terapia , Pancreatite Crônica/epidemiologia , Pâncreas , Insuficiência Pancreática Exócrina/etiologia , Insuficiência Pancreática Exócrina/terapia , Nicotiana/efeitos adversos , Consumo de Bebidas Alcoólicas/efeitos adversos , Fatores de Risco , Distribuição por Sexo , Progressão da Doença , Terapia EnzimáticaRESUMO
BACKGROUND: Alcohol and tobacco are important risk factors for chronic pancreatitis (CP). AIM: To analyze the effect of etiological factors such as tobacco and alcohol and pancreatic enzyme replacement therapy (PERT) in the progression of CP. MATERIAL AND METHODS: Patients with a diagnosis of CP were recruited and grouped according to variables such as tobacco, alcohol and PERT. They were followed for 18 months. Subsequently, different variables and analytical parameters involved in the progression of the disease were analyzed. RESULTS: A total of 50 patients diagnosed with CP were included. Of these, 28 patients underwent PERT, 39 were smokers and 33 were alcohol users. Compared with patients without PERT, those with PERT had a higher proportion of diabetes (64 and 32%, respectively), had a higher need for endoscopic treatment (25 and 0%, respectively) and a normal body mass index (71 and 27.3%, respectively. The smokers had higher calcium levels and increased lymphocytosis and leukocytosis. The alcohol consumption group had a higher mean age (p = 0.04) Conclusions: PERT may improve the nutritional status but does not reduce the need for endoscopic or surgical treatment. Smoking and alcohol consumption favored the progression of CP. Also, smoking induced a pro-inflammatory state.
Assuntos
Insuficiência Pancreática Exócrina , Pancreatite Crônica , Humanos , Insuficiência Pancreática Exócrina/etiologia , Insuficiência Pancreática Exócrina/terapia , Pancreatite Crônica/epidemiologia , Pancreatite Crônica/etiologia , Pancreatite Crônica/terapia , Pâncreas , Fatores de Risco , Nicotiana , Progressão da DoençaRESUMO
OBJECTIVES: Abdominal pain is the primary symptom of chronic pancreatitis (CP), but pain is difficult to assess, and objective methods for pain assessment are lacking. The characterization of the sensory component of pain as a surrogate for nociception can be achieved by sensory testing using standardized stimuli. Herein, we describe the rationale for and development of an international consortium to better understand and characterize CP pain. METHODS: A collaboration was initially formed between the University of Aalborg, Johns Hopkins University, and the University of Pittsburgh. This group refined the protocol for pancreatic quantitative sensory testing (P-QST) and then expanded the collaboration with plans for incorporating P-QST into prospective studies. RESULTS: The collaboration has successfully developed a P-QST nomogram. Chronic pancreatitis patients identified with P-QST as having widespread hyperalgesia had higher pain intensity scores, higher prevalence of constant pain, and decreased quality of life. Psychiatric comorbidities were independent of pain phenotypes. Multiple studies are underway to validate these findings and evaluate their utility in clinical trials. CONCLUSIONS: Development of the P-QST Consortium will facilitate collaborative efforts to use P-QST as a means for evaluation and characterization of pain in CP patients, and optimize methods to guide individualized pain management approaches.
Assuntos
Dor Abdominal/diagnóstico , Medição da Dor/métodos , Dor/diagnóstico , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/fisiopatologia , Dor Abdominal/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Nomogramas , Dor/fisiopatologia , Manejo da Dor/métodos , Pâncreas/fisiopatologia , Pancreatite Crônica/terapia , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Centros de Atenção Terciária/estatística & dados numéricosRESUMO
Recurrent acute and chronic pancreatitis are increasingly recognized in childhood. Etiologies are vastly different in children compared with adults and mostly involve genetic and anatomical factors with negligible contribution of environmental risks. Pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have significant impact on quality of life with high healthcare costs. Children with these conditions suffer from recurrent acute or chronic abdominal pain and they endure multiple emergency room visits, hospitalizations, procedures, and surgeries. Diagnostic methods are being developed; treatment options are limited. This review summarizes the most recent developments in pediatric ARP and CP. These discoveries will help physicians provide optimal care for children with these conditions.
Assuntos
Pancreatite Crônica , Qualidade de Vida , Doença Aguda , Criança , Humanos , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Pancreatite Crônica/terapia , RecidivaRESUMO
OBJECTIVES: Pancreatic duct stones contribute to pain in patients with chronic pancreatitis, and per-oral pancreatoscopy (POP) allows visualization, fragmentation, and removal of these stones. This study compared the safety and efficacy of endoscopic retrograde pancreatography (ERP) with and without POP. METHODS: This single-center retrospective review compared ERP with and without POP for treatment of main-duct pancreatic duct stones. The primary outcome was technical success, defined as partial or complete stone removal, which was compared between the 2 groups. RESULTS: In all, 223 patients underwent 549 ERPs with a technical success rate of 92.4% and complete stone clearance rate of 74.9%. Patients undergoing ERP with POP (n = 94) had higher technical success than patients undergoing ERP without POP (n = 129, 98.9% vs 87.6%, P < 0.001), but required more ERPs (3.1 vs 1.9, P = 0.02). Endoscopic retrograde pancreatography with POP was associated with larger stone size (8.9 vs 6.1 mm, P = 0.001), more stones per case (5+ stones: 33.8% vs 21.1%, P = 0.002), and more impacted stones (48.8% vs 10.3%, P < 0.001). CONCLUSIONS: Per-oral pancreatoscopy-guided lithotripsy permits effective stone removal in cases not amenable to standard ERP techniques, including those with larger or more numerous stones.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Endoscopia Gastrointestinal/métodos , Litotripsia/métodos , Pancreatopatias/terapia , Ductos Pancreáticos/patologia , Cálculos Urinários/terapia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/prevenção & controle , Pancreatite Crônica/complicações , Pancreatite Crônica/terapia , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Urinários/complicaçõesRESUMO
Chronic pancreatitis is a progressive fibro-inflammatory disease of the pancreas characterized by irreversible fibrosis of the gland with eventual failure of exocrine and endocrine functions and hallmark features of abdominal pain, malabsorption, malnutrition, diabetes mellitus and pancreatic calcifications. In many patients this disease results from a complex mix of environmental (eg, alcohol, cigarettes, and occupational chemicals), genetic factors and a few patients with hereditary or autoimmune disease. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. This review provides the reader with a comprehensive overview of the studies summarizing the epidemiology, etiology, physiopatology, clinical manifestation, diagnosis and treatments of the disease.
Assuntos
Pancreatite Crônica , Humanos , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Pancreatite Crônica/fisiopatologia , Pancreatite Crônica/terapia , Fatores de RiscoRESUMO
La pancreatitis crónica es una enfermedad fibro-inflamatoria progresiva del páncreas caracterizada por la fibrosis irreversible de la glándula con el eventual fallo de las funciones exocrinas y endocrinas. Las características distintivas de la enfermedad son el dolor abdominal, la malabsorción, la desnutrición, la diabetes mellitus y las calcificaciones pancreáticas. En muchos pacientes el origen de esta enfermedad se debe a una compleja mezcla de factores ambientales (por ejemplo, alcohol, cigarrillos y productos químicos en el trabajo), factores genéticos y en algunos casos origen hereditario o autoinmune. El manejo incluye enfoques médico, endoscópico y quirúrgico con la necesidad de la interacción entre diversas especialidades para dar un enfoque multidisciplinario coordinado. Esta revisión ofrece una visión general de los estudios recientes resumiendo la epidemiología, etiología, fisiopatología, manifestaciones clínicas, diagnóstico y tratamiento de la enfermedad.
Chronic pancreatitis is a progressive fibro-inflammatory disease of the pancreas characterized by irreversible fibrosis of the gland with eventual failure of exocrine and endocrine functions and hallmark features of abdominal pain, malabsorption, malnutrition, diabetes mellitus and pancreatic calcifications. In many patients this disease results from a complex mix of environmental (eg, alcohol, cigarettes, and occupational chemicals), genetic factors and a few patients with hereditary or autoimmune disease. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. This review provides the reader with a comprehensive overview of the studies summarizing the epidemiology, etiology, physiopatology, clinical manifestation, diagnosis and treatments of the disease.
Assuntos
Humanos , Pancreatite Crônica , Fatores de Risco , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Pancreatite Crônica/fisiopatologia , Pancreatite Crônica/terapiaRESUMO
La dilatación quística del colédoco es una entidad rara. Tiene mayor incidencia en los países orientales que en los occidentales y predomina en el sexo femenino. Se diagnostica habitualmente en la infancia y se han postulado varias hipótesis para su origen entre las que se destacan las anomalías en la unión biliopancreática. Se presenta el caso de una paciente de 19 años de edad con un quiste de colédoco tipo IV de Todani con varios años de evolución. Finalmente recibió, una derivación como tratamiento definitivo; la evolución fue inmediata y satisfactoria(AU)
Choledochal cysts are rare and has higher incidence rate in the Eastern countries than in the Western nations. It is predominant in females. It is regularly diagnosed in the childhood and several hypotheses have been formulated about their origin, being one of them the biliopancreatic junction anomalies. This is the case of a 19 years-old patient with a Todani´s type IV choledochal cyst with several years of progression. He was finally performed a shunt as definitive treatment and his recovery was immediate and satisfactory(AU)