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Multicenter Study
. 2011 Jan;33(1):149-59.
doi: 10.1111/j.1365-2036.2010.04491.x. Epub 2010 Oct 29.

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

F Burton  1 , 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 2nd, M O'Connell, E D Kennard, D Yadav, D C Whitcomb, C E Forsmark; North American Pancreatic Study Group
Affiliations
Multicenter Study

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

F Burton et al. Aliment Pharmacol Ther. 2011 Jan.

Abstract

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.

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