Use and perceived effectiveness of non‐analgesic medical therapies for chronic pancreatitis in the United States

• Published in: Alimentary pharmacology & therapeutics Vol. 33; no. 1; pp. 149 - 159
• Main Authors: Burton, F., Alkaade, S., Collins, D., Muddana, V., Slivka, A., Brand, R. E., Gelrud, A., Banks, P. A., Sherman, S., Anderson, M. A., Romagnuolo, J., Lawrence, C., Baillie, J., Gardner, T. B., Lewis, M. D., Amann, S. T., Lieb, J. G., O’Connell, M., Kennard, E. D., Yadav, D., Whitcomb, D. C., Forsmark, C. E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2011; Blackwell
• Subjects: Abdominal Pain - therapy; Adolescent; Adult; Aged; Aged, 80 and over; Alcoholics; Antioxidants; Antioxidants - therapeutic use; Autonomic Nerve Block - methods; Biological and medical sciences; Digestive system; Enzyme Replacement Therapy; Enzymes; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Agents - therapeutic use; Humans; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; octreotide; Octreotide - therapeutic use; Other diseases. Semiology; Pain; Pancreas; Pancreas - pathology; Pancreatitis; Pancreatitis, Chronic; Pharmacology. Drug treatments; Prospective Studies; Surveys and Questionnaires; Treatment Outcome; United States; Vitamins; Vitamins - therapeutic use; Young Adult; United States; North America; America; Medicine; Chronic; Analgesic; Treatment; Efficiency; Pancreatitis; Digestive diseases; Pancreatic disease
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2010.04491.x

Aliment Pharmacol Ther 2011; 33: 149–159 Summary 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.