Pancreatic tissue fluid pressure and pain in chronic pancreatitis

A casual relation between pancreatic pressure and pain has been searched for decades but lack of appropriate methods for pressure measurements has hindered progress. During the 1980's the needle method has been used for direct intraoperative pancreatic tissue fluid pressure measurements and later for percutaneous sonographically-guided pressure measurements. Clinical and experimental evaluation of the method showed comparable results at intraoperative and percutaneous measurements and little week-to-week variation. Furthermore, comparable pressures in duct and adjacent pancreatic tissue were found, i.e. the needle pressure mirrors the intraductal pressure. Comparisons of pain registrations, morphological and functional parameters with pancreatic tissue fluid pressure measurements have revealed a relation between pressure and pain which probably is causal. In patients with pain the high pressures previously reported have been confirmed, and pressures are normal or only slightly elevated in patients without pain. It seems evident that a substantial pressure decrease during drainage operations leads to freedom of pain. The pancreatic tissue fluid pressure elicits considerable regional differences in patients with painful chronic pancreatitis. These differences are significantly larger across a stenosis in the duct than across normal duct, but there is no significant relation between pressure and duct diameter. The median pressure is significantly related only to cavities in the pancreas, but not to ERP-findings, calcifications or residual pancreatic exocrine function. Drainage operations cause an overall pressure decrease of approximately 50%, the end pressure being slightly but not significantly elevated compared to normal but with considerable inter- and intraindividual variation.(ABSTRACT TRUNCATED AT 250 WORDS)