title: Chronic Gastrointestinal Dysmotility and Pain Following Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis.
abstract: The prevalence and impact of chronic gastrointestinal dysmotility following total pancreactectomy with islet autotransplantation (TP-IAT) for chronic pancreatitis is not known.
  
  
  
  A cross-sectional study of all patients who underwent TP-IAT at our institution from August 2011 to November 2015 was undertaken. The GCSI (Gastroparesis Cardinal Symptom Index), PAGI-SYM (Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index), PAC-SYM (Patient Assessment of Constipation Symptoms), Bristol stool chart, 12-item Short Form Health Survey (SF-12), and visual analog scale for pain were administered ≥4 weeks following TP-IAT.
  
  
  
  The prevalence of any dysmotility symptoms in patients who completed the survey (33/45, 73%) post-TP-IAT was 45%. Post-TP-IAT, the mean reduction in opioid dosing was 77.6 oral morphine equivalents (OMEs) (95% CI 32.1-123.0, p = 0.002) with 42% of patients requiring no opioids. There was significant negative correlation between dysmotility scores and SF-12 physical scores (r = -0.46, p = 0.008, 95% CI -0.70 to -0.13). Self-reported abdominal pain had significant negative correlation with both physical and mental SF-12 scores (r = -0.67, p < 0.001, 95% CI -0.83 to -0.41 and r = -0.39, p = 0.03, 95% CI -0.65 to -0.04). There was no correlation between gastrointestinal dysmotility and self-reported pain.
  
  
  
  Symptoms of chronic gastrointestinal dysmotility and chronic abdominal pain are common post-TP-IAT and will need to be better recognized and differentiated to improve the management of these patients.
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: George K
authors.initials: GK
authors.lastname: John
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.|Pancreatitis Center, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.|Pancreatitis Center, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Moran
authors.affiliation: Division of Surgical Oncology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Warren
authors.affiliation: Division of Surgical Oncology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: Zhaoli
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Division of Surgical Oncology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: Niraj
authors.initials: N
authors.lastname: Desai
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: Christi
authors.initials: C
authors.lastname: Walsh
authors.affiliation: Division of Transplant Surgery, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: Rita R
authors.initials: RR
authors.lastname: Kalyani
authors.affiliation: Division of Transplant Surgery, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Hall
authors.affiliation: Pancreatitis Center, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.|Division of Surgical Oncology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.affiliation: Pancreatitis Center, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.|Division of Surgical Oncology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA. estein6@jhmi.edu.|Pancreatitis Center, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA. estein6@jhmi.edu.|Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA. estein6@jhmi.edu.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Stein
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D005260:Female; D005769:Gastrointestinal Motility; D018589:Gastroparesis / Q000209:etiology*; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D010180:Pancreatectomy / Q000009:adverse effects*; D050500:Pancreatitis, Chronic / Q000601:surgery; D011788:Quality of Life; D057566:Self Report; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic pancreatitis; Post-TP-IAT dysmotility; QOL