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

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

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.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Pain / therapy*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antioxidants / therapeutic use*
  • Autonomic Nerve Block / methods
  • Enzyme Replacement Therapy
  • Female
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Octreotide / therapeutic use*
  • Pancreas / pathology
  • Pancreatitis, Chronic
  • Prospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome
  • United States
  • Vitamins / therapeutic use*
  • Young Adult

Substances

  • Antioxidants
  • Gastrointestinal Agents
  • Vitamins
  • Octreotide