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Chronic pancreatitis
1Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Current Opinion in Gastroenterology
|October 13, 2006
Summary
Recent research clarifies painful chronic pancreatitis and hereditary pancreatitis linked to trypsinogen gene mutations. Early diagnosis remains challenging, with novel tests showing limited sensitivity for pancreatic function.
Area of Science:
- Gastroenterology
- Pancreatology
- Medical Genetics
Background:
- Recent clinical studies offer insights into the nature and progression of painful chronic pancreatitis.
- Novel mutations in the cationic trypsinogen gene are identified in hereditary pancreatitis cases, though their pathogenic mechanisms are unclear.
- Diagnosing early chronic pancreatitis presents challenges, complicated by findings like pancreatic fibrosis in alcoholics and difficulties in managing pancreatic steatorrhea.
Purpose of the Study:
- To review recent advancements in understanding chronic pancreatitis.
- To discuss the implications of novel genetic findings in hereditary pancreatitis.
- To evaluate current diagnostic challenges and emerging noninvasive tests for pancreatic function.
Main Methods:
- Literature review of key clinical papers and genetic studies published in the past year.
- Analysis of novel noninvasive pancreatic function tests, such as postprandial APOB-48 measurement.
- Evaluation of diagnostic imaging and clinical findings in chronic pancreatitis.
Main Results:
- A significant clinical paper has elucidated the characteristics and natural history of painful chronic pancreatitis.
- Several new mutations in the cationic trypsinogen gene associated with hereditary pancreatitis have been identified.
- A novel noninvasive pancreatic function test (postprandial APOB-48) shows limited sensitivity.
- Interpreting endoscopic ultrasonogram findings is difficult due to frequent pancreatic fibrosis in alcoholics.
- Managing pancreatic steatorrhea remains challenging, and fibrosing colonopathy has been reported in adults.
- Combined extracorporeal shockwave lithotripsy and endoscopic therapy showed no benefit for calcific chronic pancreatitis.
Conclusions:
- Understanding painful chronic pancreatitis has improved, with clinical implications for patient management.
- The role of cationic trypsinogen gene mutations in hereditary pancreatitis requires further investigation.
- Current diagnostic methods for early chronic pancreatitis are insufficient, necessitating the development of more sensitive and reliable tests.
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