Painless Chronic Pancreatitis Linked to Exocrine, Endocrine Insufficiency

Pancreatitis. Computer artwork of a womans torso showing pain radiating from her pancreas (orange) due to pancreatitis. Pancreatitis, which can be acute or chronic, is typically caused by alcohol abuse, but can also be caused by gallstones. Abdominal injury, viral infections and certain drugs may also causes attacks. It causes sudden sharp pain in the upper abdomen, which is often followed by vomiting and nausea. The acute form is diagnosed from abnormal levels of pancreatic enzymes in the blood, but the chronic form may require direct observation of the organ with an endoscope. The chronic form is treated with pain- killers and drugs to aid the pancreas functions.
Investigators assessed the prevalence and characteristics of painless chronic pancreatitis, which is often overlooked.

Painless chronic pancreatitis (CP) has been observed in 10% of cases and is frequently associated with exocrine pancreatic insufficiency (EPI), according to study results published in Digestive and Liver Disease.

Onset of CP is commonly characterized by pain or episodes of pancreatitis, generally in the first years (early CP), and by exocrine and endocrine insufficiency in a later phase (end-stage CP). Thus, painless CP is a rare form of the disease. Researchers sought to evaluate the prevalence and the characteristics of this overlooked form of pancreatitis by observing patients with a diagnosis of CP referred to a tertiary center for pancreatic diseases in Italy between January 2010 and December 2016. Among 781 patients who experienced CP during this time, only 74 patients (9.5%; 50 men and 24 women) had painless CP. Mean age at diagnosis was 60.8±10.8 (range, 30-91) years. Of these patients, 38 (51%) did not report any symptoms and 36 (49%) were affected by symptoms other than pain. Pancreatic calcifications were diagnosed in 70 (95%) patients, main pancreatic duct dilation > 6 mm in 55 (74%), and pancreatic atrophy in 39 (53%). A total of 36 (55%) patients had severe EPI and 34 of 72 patients (47%) had diabetes. No patient underwent endoscopic treatment or surgery, developed pancreatic cancer, or died.

“Painless CP represents a form of the disease not infrequent in a tertiary center, often associated with pancreatic exocrine and endocrine insufficiency,” concluded the authors.

They added, “The probability of onset of pain is low in a short-term follow-up and, therefore, a conservative approach seems to be the most appropriate.”

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Amodio A, De Marchi G, de Pretis N, et al. Painless chronic pancreatitis. Published online  September 10, 2020. Dig Liver Dis. doi: 10.14309/ctg.0000000000000232