title: Use and perceived effectiveness of non-analgesic medical therapies for chronic pancreatitis in the United States.
abstract: BACKGROUND
  Effectiveness of medical therapies in chronic pancreatitis has been described in small studies of selected patients.
  
  
  OBJECTIVE
  To describe frequency and perceived effectiveness of non-analgesic medical therapies in chronic pancreatitis patients evaluated at US referral centres.
  
  
  METHODS
  Using data on 516 chronic pancreatitis patients enrolled prospectively in the NAPS2 Study, we evaluated how often medical therapies [pancreatic enzyme replacement therapy (PERT), vitamins/antioxidants (AO), octreotide, coeliac plexus block (CPB)] were utilized and considered useful by physicians.
  
  
  RESULTS
  Oral PERT was commonly used (70%), more frequently in the presence of exocrine insufficiency (EI) (88% vs. 61%, P < 0.001) and pain (74% vs. 59%, P < 0.002). On multivariable analyses, predictors of PERT usage were EI (OR 5.14, 95% CI 2.87-9.18), constant (OR 3.42, 95% CI 1.93-6.04) or intermittent pain (OR 1.98, 95% CI 1.14-3.45). Efficacy of PERT was predicted only by EI (OR 2.16, 95% CI 1.36-3.42). AO were tried less often (14%) and were more effective in idiopathic and obstructive vs. alcoholic chronic pancreatitis (25% vs. 4%, P = 0.03). Other therapies were infrequently used (CPB - 5%, octreotide - 7%) with efficacy generally <50%.
  
  
  CONCLUSIONS
  Pancreatic enzyme replacement therapy is commonly utilized, but is considered useful in only subsets of chronic pancreatitis patients. Other medical therapies are used infrequently and have limited efficacy.
authors.affiliation: St. Louis University, MO, USA.
authors.forename: F
authors.initials: F
authors.lastname: Burton
authors.forename: S
authors.initials: S
authors.lastname: Alkaade
authors.forename: D
authors.initials: D
authors.lastname: Collins
authors.forename: V
authors.initials: V
authors.lastname: Muddana
authors.forename: A
authors.initials: A
authors.lastname: Slivka
authors.forename: R E
authors.initials: RE
authors.lastname: Brand
authors.forename: A
authors.initials: A
authors.lastname: Gelrud
authors.forename: P A
authors.initials: PA
authors.lastname: Banks
authors.forename: S
authors.initials: S
authors.lastname: Sherman
authors.forename: M A
authors.initials: MA
authors.lastname: Anderson
authors.forename: J
authors.initials: J
authors.lastname: Romagnuolo
authors.forename: C
authors.initials: C
authors.lastname: Lawrence
authors.forename: J
authors.initials: J
authors.lastname: Baillie
authors.forename: T B
authors.initials: TB
authors.lastname: Gardner
authors.forename: M D
authors.initials: MD
authors.lastname: Lewis
authors.forename: S T
authors.initials: ST
authors.lastname: Amann
authors.forename: J G
authors.initials: JG
authors.lastname: Lieb
authors.forename: M
authors.initials: M
authors.lastname: O'Connell
authors.forename: E D
authors.initials: ED
authors.lastname: Kennard
authors.forename: D
authors.initials: D
authors.lastname: Yadav
authors.forename: D C
authors.initials: DC
authors.lastname: Whitcomb
authors.forename: C E
authors.initials: CE
authors.lastname: Forsmark
mesh_terms: D015746:Abdominal Pain / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000627:therapeutic use*; D001340:Autonomic Nerve Block / Q000379:methods; D056947:Enzyme Replacement Therapy; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D010179:Pancreas / Q000473:pathology; D050500:Pancreatitis, Chronic; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D014815:Vitamins / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000975:Antioxidants; D005765:Gastrointestinal Agents; D014815:Vitamins; D015282:Octreotide