C Mel Wilcox1, Dhiraj Yadav2, Tian Ye3, Timothy B Gardner4, Andres Gelrud5, Bimaljit S Sandhu6, Michele D Lewis7, Samer Al-Kaade8, Gregory A Cote9, Christopher E Forsmark10, Nalini M Guda11, Darwin L Conwell12, Peter A Banks12, Thiruvengadam Muniraj13, Joseph Romagnuolo14, Randall E Brand2, Adam Slivka2, Stuart Sherman9, Stephen R Wisniewski3, David C Whitcomb2, Michelle A Anderson15. 1. University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: melw@uab.edu. 2. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 3. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania. 4. Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 5. University of Chicago School of Medicine, Chicago, Illinois. 6. Virginia Commonwealth University School of Medicine, Richmond, Virginia. 7. Mayo Clinic, Jacksonville, Florida. 8. Saint Louis University School of Medicine, St. Louis, Missouri. 9. Indiana University School of Medicine, Indianapolis, Indiana. 10. University of Florida College of Medicine, Gainesville, Florida. 11. University of Wisconsin School of Medicine, Milwaukee, Wisconsin. 12. Brigham and Women's Hospital, Boston, Massachusetts. 13. Griffin Hospital, Derby, Connecticut. 14. Medical University of South Carolina, Charleston, South Carolina. 15. University of Michigan School of Medicine, Ann Arbor, Michigan.
Abstract
BACKGROUND & AIMS: Chronic pancreatitis is characterized by inflammation, atrophy, fibrosis with progressive ductal changes, and functional changes that include variable exocrine and endocrine insufficiency and multiple patterns of pain. We investigated whether abdominal imaging features accurately predict patterns of pain. METHODS: We collected data from participants in the North American Pancreatitis Study 2 Continuation and Validation, a prospective multicenter study of patients with chronic pancreatitis performed at 13 expert centers in the United States from July 2008 through March 2012. Chronic pancreatitis was defined based on the detection of characteristic changes by cross-sectional abdominal imaging, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, or histology analyses. Patients were asked by a physician or trained clinical research coordinator if they had any abdominal pain during the year before enrollment, those who responded "yes" were asked to select from a list of 5 pain patterns. By using these patterns, we classified patients' pain based on timing and severity. Abnormal pancreatitis-associated features on abdominal imaging were recorded using standardized case report forms. RESULTS: Data were collected from 518 patients (mean age, 52 ± 14.6 y; 55% male; and 87.6% white). The most common physician-identified etiologies were alcohol (45.8%) and idiopathic (24.3%); 15.6% of patients reported no abdominal pain in the year before enrollment. The most common individual pain pattern was described as constant mild pain with episodes of severe pain and was reported in 45% of patients. The most common imaging findings included pancreatic ductal dilatation (68%), atrophy (57%), and calcifications (55%). Imaging findings were categorized as obstructive for 20% and as inflammatory for 25% of cases. The distribution of individual imaging findings was similar among patients with different patterns of pain. The distribution of pain patterns did not differ among clinically relevant groups of imaging findings. CONCLUSIONS: Mechanisms that determine patterns and severity of pain in patients with chronic pancreatitis are largely independent of structural variants observed by abdominal imaging techniques. Pancreas-relevant quantitative and qualitative pain measures should be included in the evaluation of patients with chronic pancreatitis to assess pain severity independently of imaging findings.
BACKGROUND & AIMS:Chronic pancreatitis is characterized by inflammation, atrophy, fibrosis with progressive ductal changes, and functional changes that include variable exocrine and endocrine insufficiency and multiple patterns of pain. We investigated whether abdominal imaging features accurately predict patterns of pain. METHODS: We collected data from participants in the North American Pancreatitis Study 2 Continuation and Validation, a prospective multicenter study of patients with chronic pancreatitis performed at 13 expert centers in the United States from July 2008 through March 2012. Chronic pancreatitis was defined based on the detection of characteristic changes by cross-sectional abdominal imaging, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, or histology analyses. Patients were asked by a physician or trained clinical research coordinator if they had any abdominal pain during the year before enrollment, those who responded "yes" were asked to select from a list of 5 pain patterns. By using these patterns, we classified patients' pain based on timing and severity. Abnormal pancreatitis-associated features on abdominal imaging were recorded using standardized case report forms. RESULTS: Data were collected from 518 patients (mean age, 52 ± 14.6 y; 55% male; and 87.6% white). The most common physician-identified etiologies were alcohol (45.8%) and idiopathic (24.3%); 15.6% of patients reported no abdominal pain in the year before enrollment. The most common individual pain pattern was described as constant mild pain with episodes of severe pain and was reported in 45% of patients. The most common imaging findings included pancreatic ductal dilatation (68%), atrophy (57%), and calcifications (55%). Imaging findings were categorized as obstructive for 20% and as inflammatory for 25% of cases. The distribution of individual imaging findings was similar among patients with different patterns of pain. The distribution of pain patterns did not differ among clinically relevant groups of imaging findings. CONCLUSIONS: Mechanisms that determine patterns and severity of pain in patients with chronic pancreatitis are largely independent of structural variants observed by abdominal imaging techniques. Pancreas-relevant quantitative and qualitative pain measures should be included in the evaluation of patients with chronic pancreatitis to assess pain severity independently of imaging findings.
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