title: Long-term prognosis of duct-narrowing chronic pancreatitis: strategy for steroid treatment.
abstract: OBJECTIVE
  The purpose of this study was to assess the long-term prognosis in patients with duct-narrowing chronic pancreatitis (DNCP) and determine the indications for steroid therapy.
  
  
  METHODS
  We evaluated clinical and imaging outcomes in patients with DNCP classified into 3 groups (A, B, and C) according to the treatment given. Group A included 6 patients who underwent surgical resection. Groups B and C included 21 and 10 patients treated medically with and without steroid therapy, respectively.
  
  
  RESULTS
  In group A, 2 patients relapsed in the remnant pancreas. In group B, pancreatic swelling was resolved in all the patients, and moreover, both the irregular narrowing of the main pancreatic duct (MPD) and the strictures of the common bile duct (CBD) improved after initiation of corticosteroid therapy in all but 1 of the patients, including 5 without immunoserologic abnormality. However, clinical recurrences occurred in 4 patients (19%) during or after the maintenance therapy. In group C, all the patients showed an improvement in swelling of the gland, while only 5 showed improvement of pancreatic duct involvement. Four of these 5 patients did not show any serologic data suggesting autoimmune abnormality or CBD involvement. In all the other 5 patients in whom MPD irregularities did not improve, bile duct strictures or positive immunoserologic test results were noted.
  
  
  CONCLUSIONS
  Steroid therapy is effective for improving pancreatic duct and bile duct lesions in patients with DNCP and is indicated particularly in those with CBD strictures or immunoserologic abnormality, although some patients have recurrences.
authors.affiliation: Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan.
authors.forename: Tokio
authors.initials: T
authors.lastname: Wakabayashi
authors.forename: Yukimitsu
authors.initials: Y
authors.lastname: Kawaura
authors.forename: Yositake
authors.initials: Y
authors.lastname: Satomura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Motoo
authors.forename: Norio
authors.initials: N
authors.lastname: Sawabu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D004487:Edema / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D010183:Pancreatic Ducts / Q000473:pathology*; D050500:Pancreatitis, Chronic / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones