Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients

Abstract

Over the last 20 yr, 245 patients with chronic pancreatitis (163 with alcoholic relapsing pancreatitis; 145 of them with calcific pancreatitis) were prospectively studied at regular intervals with particular regard to pain, pancreatic functions, calcifications, pancreatic surgery, and survival. The median period of observation in the group with alcoholic relapsing calcific pancreatitis was 10.4 yr. In this group of 145 patients, 85% experienced lasting pain relief within a median time of 4.5 yr from onset. A gradual increase of pancreatic calcifications and pancreatic dysfunction was observed with increasing duration of the disease. Pain relief was accompanied by a marked increase in pancreatic dysfunction and calcification. Of 163 patients with alcoholic relapsing pancreatitis, 87 (53%) needed no pancreatic surgery. Seventy-six patients (47%) with recurrent or persistent severe pain, mainly due to pseudocysts (n = 56), underwent either a cyst drainage procedure (n = 22), papillotomy (n = 4), distal pancreatectomy (40%-60%, n = 24), or Wirsungo-jejunostomy (n = 26). The proportion of patients experiencing lasting pain relief was similar in the operated and nonoperated group of patients. In both groups lasting relief from pain was correlated with the duration of the disease and was associated with marked pancreatic dysfunction. The 50% survival time in alcoholic chronic pancreatitis (with or without pancreatic surgery) was 20-24 yr (after onset), thus markedly shorter than in nonalcoholic pancreatitis. Of the 245 patients, 86 died. About 20% of deaths were related to pancreatitis and its complications. Most extrapancreatic causes of death were malignancies, cardiovascular diseases, severe infections, and nonpancreatic surgery.