Document Detail


Use and perceived effectiveness of non-analgesic medical therapies for chronic pancreatitis in the United States.
MedLine Citation:
PMID:  21083584     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Effectiveness of medical therapies in chronic pancreatitis has been described in small studies of selected patients.
AIM: 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:
F Burton; S Alkaade; D Collins; V Muddana; A Slivka; R E Brand; A Gelrud; P A Banks; S Sherman; M A Anderson; J Romagnuolo; C Lawrence; J Baillie; T B Gardner; M D Lewis; S T Amann; J G Lieb; M O'Connell; E D Kennard; D Yadav; D C Whitcomb; C E Forsmark;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-10-29
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  33     ISSN:  1365-2036     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-06     Completed Date:  2011-05-06     Revised Date:  2012-01-04    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  149-59     Citation Subset:  IM    
Copyright Information:
© 2010 Blackwell Publishing Ltd.
Affiliation:
St. Louis University, MO, USA.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Pain / therapy*
Adolescent
Adult
Aged
Aged, 80 and over
Antioxidants / therapeutic use*
Autonomic Nerve Block / methods
Enzyme Replacement Therapy
Female
Gastrointestinal Agents / therapeutic use*
Humans
Male
Middle Aged
Octreotide / therapeutic use*
Pancreas / pathology
Pancreatitis, Chronic
Prospective Studies
Questionnaires
Treatment Outcome
United States
Vitamins / therapeutic use*
Young Adult
Grant Support
ID/Acronym/Agency:
DK61451/DK/NIDDK NIH HHS; R01 DK061451-01/DK/NIDDK NIH HHS; R01 DK061451-02/DK/NIDDK NIH HHS; R01 DK061451-03/DK/NIDDK NIH HHS; R01 DK061451-04/DK/NIDDK NIH HHS; R01 DK061451-05/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Antioxidants; 0/Gastrointestinal Agents; 0/Vitamins; 83150-76-9/Octreotide

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