Enzyme Supplementation for Pain in Chronic Pancreatitis

Pain is the dominant clinical problem in chronic pancreatitis. However, its cause or causes are still poorly understood. The idea that increased intraductal pressure is associated with pain has lately gained support from several studies. In 1982 Bradley [7] reported significantly increased ductal pressure in 19 patients with chronic pancreatitis as measured during operation for pain. A drawback with this study was that the control values were obtained endoscopically (patients without any signs of pancreatic disease). The findings were repeated however, by Sato et al. [27], who in an intraoperative study found elevation of both ductal perfusion and residual pressure in patients with chronic pancreatitis compared to controls who had surgery for gastric cancer. Also, Madsen and Winkler [22] reported high ductal pressure as measured intraoperatively in patients with chronic pancreatitis. In an endoscopic study Okazaki et al. [23] made similar findings, and they could even demonstrate a statistically significant increase of the ductal pressure in chronic pancreatitis patients with pain by comparison with a group of patients with painless disease. Interestingly, Ebbehoj et al. [9] were able to record pancreatic tissue pressure during surgery and measured higher values in chronic pancreatitis than in controls, and after ductal drainage a significant drop in tissue pressure was found.