Natural course of abdominal pain in chronic pancreatitis with intermittent (type A) pain after conservative treatment.
BACKGROUND
Abdominal pain in chronic pancreatitis (CP) is difficult to treat and appropriate choice of treatment is controversial. It has been suggested that patients with CP particularly from alcohol (ACP) with intermittent attack of abdominal pain (type A pain) should be managed conservatively because pain relief will be achieved in most cases. However, data of the efficacy of this strategy is scanty and conflicting and whether this strategy is effective or feasible in idiopathic CP (ICP) is unclear.


METHODS
Data of all patients with CP with type A pain, who were followed-up and managed conservatively during 2004-2008 were analyzed. Pain relief was defined by the absence of abdominal pain for more than 1 year


RESULTS
Twenty-two patients were followed-up with a median duration of 31 months (range 5-96 months). The etiology of CP was alcoholic (ACP) in 12 (56%), early-onset idiopathic (E-ICP) in 5 (22%) and late-onset idiopathic (L-ICP) in 5 (22%). Alcohol abstinence was successful in every ACP patient. Overall, 18 patients (82%) had pain relief with a median duration of 39 months (range 16-167 months) from the onset of pain or 14 months (range 11-57 months) from the time of diagnosis of CP. Pain relief was achieved at a higher level mainly in ACP (100%) and L-ICP (80%) but was only 40% in E-ICP Median duration from onset until pain relief were 28 months (range 16-167 months) for ACP, 36 months (range 16-39 months) for L-ICP and 120 months (range 42-120 months) for E-ICP. The difference was statistically significant between L-ICP and E-ICP (p = 0.036), but not between ACP and E-ICP (p = 0.13) and between ACP and L-ICP (p = 0.80). Median duration from the time of diagnosis of CP until pain relief was only 14 months forACP 13 months for L-ICP but was 52 months for E-ICP. None of the patients required narcotics, endoscopic therapy or surgery.


CONCLUSIONS
Conservative management was feasible and effective in most patients with CP and type A pain, particularly ACP after alcohol abstinence, and L-ICP Conservative treatment was not effective in E-ICP.
Pongprasobchai
Supot
S
Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Bangkok, Thailand. supotpong@hotmail.com
Manatsathit
Sathaporn
S
D015746:Abdominal Pain / Q000209:etiology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D050500:Pancreatitis, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult