Management of pain in chronic pancreatitis with emphasis on exogenous pancreatic enzymes

• 作者: David Y Graham Paul M Hobbs William G Johnson
• 来源期刊: 世界胃肠药理与治疗学杂志：英文版（电子版）
• 学科: 医学
• 关键词: PANCREATIC enzyme replacement therapy Chronic pancreatitis PANCREATIC INSUFFICIENCY Protease Clinical trials TRYPSIN Fat MALABSORPTION PAIN
• 年，卷（期）: 2016,（3）
• 页码范围: 370-386
• 页数: 17页
• 分类号: R576

摘要

One of the most challenging issues arising in patients with chronic pancreatitis is the management of abdominal pain. Many competing theories exist to explain pancreatic pain including ductal hypertension from strictures and stones, increased interstitial pressure from glandular fibrosis, pancreatic neuritis, and ischemia. This clinical problem is superimposed on a background of reduced enzyme secretion and altered feedback mechanisms. Throughout history, investigators have used these theories to devise methods to combat chronic pancreatic pain including: Lifestyle measures, antioxidants, analgesics, administration of exogenous pancreatic enzymes, endo-scopic drainage procedures, and surgical drainage and resection procedures. While the value of each modality has been debated over the years, pancreatic enzyme therapy remains a viable option. Enzyme therapy restores active enzymes to the small bowel and targets the altered feedback mechanism that lead to increased pancreatic ductal and tissue pressures, ischemia, and pain. Here, we review the mechanisms and treatments for chronic pancreatic pain with a specific focus on pancreatic enzyme replacement therapy. We also discuss different approaches to overcoming a lack of clinical response update ideas for studies needed to improve the clinical use of pancreatic enzymes to ameliorate pancreatic pain.