Introduction: Health-related quality of life is becoming a major issue in the evaluation of any therapeutic intervention in patients with chronic diseases. Aim: To assess the quality of life in a large group of patients with chronic pancreatitis. Subjects and Methods: A total of 190 consecutive patients (157 M, 33 F; mean age 58.6 years, range 18–92) with proven chronic pancreatitis were studied. The mean age of onset of the pancreatitis was 42.3±14.8 years and the mean time interval between diagnosis and admission to the study was 201±141 months (range 0–629 months). The etiology was alcohol abuse in 147 patients (77.4%), due to other causes in 11 (5.8%); in the remaining 32 patients (16.8%), the pancreatitis was idiopathic. Fifty-two patients of the 147 drinkers (35.4%) continued to drink alcohol after the diagnosis of chronic pancreatitis. One hundred and forty-seven patients (77.4%) were smokers and 89 of them (60.5%) continued to smoke at the time of the study. One hundred and twenty-four patients (65.3%) had pancreatic calcification, 75 (39.5%) had pseudo-cysts, and 133 (70.0%) had a dilatation of the Wirsung duct. Fecal elastase and/or fecal chymotrypsin were evaluated in 94 patients; 80 of them (85.1%) had pancreatic insufficiency. One hundred patients (52.6%) had diabetes secondary to pancreatitis. Eighty patients (42.1%) had had pancreatic surgery for chronic pancreatitis and 16 (8.4%) underwent endotherapy. A histological diagnosis of chronic pancreatitis was available in 79 patients (41.6%). Sixty-five patients (34.2%) had pancreatic pain in the month before the study enrollment. The SF-36 questionnaire was used for assessing the health-related quality of life. Results: The z-scores of the 8 domains of the patients with chronic pancreatitis were significantly negative indicating an overall impairment of the quality of life when compared to the Italian normative sample. Pancreatic pain was the unique clinical variable able to significantly impair all 8 domains of the SF-36, while Wirsung dilation and diabetes were negatively related to some physical and mental domains. Body mass index was the unique variable positively related with some SF-36 domains. Conclusions: Pain may be considered the most important factor affecting the quality of life of chronic pancreatitis patients.
Severe acute pancreatitis still has a high mortality rate and multiple organ failure is considered to be a severe complication of the disease. Activated polymorphonuclear leukocytes have an important role in the development of multiple organ failure which may result from acute pancreatitis and they are an important pathogenetic factor in the severity of this disease. Therefore, a logical therapeutic approach is to limit the organ damage by selective suppression of inflammatory mediators involved in the systemic inflammatory response syndrome and protect against systemic complication. In this paper, we review the recent literature data on the possible manipulation of the immune response in acute pancreatitis.
Salmonella has been identified as a causative agent of acute pancreatitis.We prospectively evaluated the frequency of acute pancreatitis, pancreatic enzyme elevation and morphological pancreatic abnormalities in patients with Salmonella infection.Thirty consecutive patients with salmonellosis (Salmonella enterica serovar Enteritidis: n=25; Salmonella enterica serovar Typhimurium: n=5) and 30 sex- and age-matched healthy subjects were studied.All subjects underwent serum amylase and lipase determination and ultrasonography.None of the subjects developed acute pancreatitis. Two patients (6.7%) and two controls showed serum amylase activity above the upper reference limit whereas, in five patients (16.7%) and one control subject (3.3%), the serum lipase activity appeared above the upper reference limit. Salmonella infection significantly increased serum activity of lipase (P<0.001) while it did not significantly affect serum amylase levels (P=0.204). Serum lipase activity was significantly higher in patients infected by Salmonella enterica serovar Typhimurium than in those infected by Salmonella enterica serovar Enteritidis (P=0.012). Ultrasonography did not show pancreatic abnormalities in any of the subjects.Our data demonstrated an elevation of serum lipase activity in gastroenteritis due to Salmonella infection, but this elevation does not seem to have clinical significance. The elevation of serum lipase seems to be particularly related to infection from Salmonella enterica serovar Typhimurium.
A 54 year-old man was admitted for a recent onset of epigastric pain radiated to the back. His clinical history was unremarkable. On admission, laboratory findings revealed leukocyte count of 17.18 10/μL, hemoglobin of 11.1 g/dL, hematocrit 32.2%, ESR of 11 mm/h, amylase 2,540 IU/L (reference values: 0-220 IU/L), lipase 2,820 IU/L (reference values: 0-270 IU/L). Abdominal examination revealed a tender, palpable epigastric mass. Thoracic and cardiovascular system were normal. An abdominal ultrasonography showed an abnormal pancreatic echotexture with a mass localized to the head of the gland (Image 1). A contrast-enhanced CT scan confirmed the presence of a retroperitoneal mass involving the head of the pancreas (Image 2). During hospitalization the patient developed hypercalcemia (16.6 mg/dL), which was treated medically, and the abdominal pain persisted although serum pancreatic enzymes progressively decreased. An ultrasoundguided biopsy of the retroperitoneal mass was performed.
To evaluate the clinical value of a new direct and competitive immunoassay for trypsinogen activation peptide (TAP) determination in acute pancreatitis (AP).The subjects were 34 patients with AP (22 mild, 12 severe), 12 patients with nonpancreatic acute abdominal pain (AA), 11 healthy subjects (HS), and 16 consecutive patients who underwent therapeutic ERCP (ERCP). Serum TAP, amylase, and lipase levels were determined in AP, AA, and HS at their initial observation; the AP patients were also studied for 6 consecutive days after admission. In the ERCP patients, serum TAP, amylase, and lipase levels, as well as urine TAP and amylase levels, were determined before and 6 hours after endoscopy.Serum TAP levels on admission were 0.35 +/- 1.60 OD (mean +/- SD) in AP patients and 0.005 +/- 0.001 OD in AA patients, while HS patients had no detectable serum TAP levels. ERCP patients had no detectable serum TAP levels before and 6 hours after the ERCP, whereas urine TAP concentrations were 1.72 +/- 3.43 OD and 0.75 +/- 1.49 OD before and 6 hours after the execution of the endoscopy, respectively (P = 0.249). The sensitivities and specificities of serum TAP, amylase, and lipase levels in discriminating between AP and AA were 23.5% and 91.7%, 94.1% and 100%, and 97.1% and 100%, respectively, while those used in the assessment of the severity of AP were 29.9% and 73.5%, 38.8% and 81.2%, and 28.4% and 83.6%, respectively.TAP is of limited value in assessing the diagnosis and the severity of acute pancreatic damage.
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