SAN ANTONIO – Acute pancreatitis (AP) can be challenging to diagnose based solely on a patient’s description of abdominal pain and elevated levels of pancreatic enzymes but without results of contrast-enhanced cross sectional imaging. Faghih, et al, presented results of their study evaluating the diagnosis of acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) at Johns Hopkins University Hospital. The presentation occurred at the American College of Gastroenterology 2019 Annual Scientific Meeting held October 25-30 in San Antonio, Texas.

ARP was divided into several subgroups based on the presence of abdominal pain and amylase and/or lipase > 3x upper limit of normal (ULN) with imaging to confirm AP (definite), abdominal pain and laboratory test results >3x ULN without imaging (probable), and >2 episodes of abdominal pain and laboratory test results <3x ULN without imaging (possible).1 CP was defined using M-ANNHEIM criteria.1

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Of the 854 patients evaluated, 57.2% had definite ARP, 19% had probable ARP, and 23.7% had possible ARP.1 Imaging results that included calcifications and ductal changes were seen only in definite ARP.1 The highest rates of exocrine insufficiency were seen in patients with definite ARP. Patients with probable ARP had higher rates of chronic opioid use compared with those with definite and possible ARP.1 Other characteristics (alcohol use, smoking, body mass index, diabetes) were all similar among the 3 ARP groups.1 The authors suggested that based on these findings, the criteria for defining AP may need updating.   


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As mentioned above, abdominal pain in patients with CP can be challenging to assess and treat. The same research group led by Faghih, et al, recently published an abstract evaluating quantitative sensory testing (QST) as a modality to more accurately predict a patient’s response to analgesics and future pain status.2 This was a multicenter, cross-sectional study in which patients with CP completed several questionnaires and underwent QST to determine pain detection thresholds.2 Pain detection thresholds were derived from multiple “pancreatic dermatomes” and used to define different pain modulatory phenotypes (PMPs). 

A total of 91 patients enrolled in the study with 3 distinct PMPs identified: normal, segmental sensitization, and widespread sensitization.2 Patients with widespread sensitization had higher pain scores and lower quality of life. Psychological profiles were similar across all 3 groups.2

This study highlights a unique way to assess abdominal pain in patients with CP; however, the practicality, both for the patient and the physician, may be challenging to incorporate into routine practice. Larger, future studies will help provide additional information to assess the role of QST and PMPs in patients with CP. 

References

1. Faghih M, Yahyapourjalaly N, Boortalary T, et al. Calcifications and moderate to marked ductal changes are only seen in patients with imaging documented acute recurrent pancreatitis. Presented at: American College of Gastroenterology 2019 Annual Scientific Meeting; October 25-30, 2019; San Antonio, TX. Abstract P0936.

2. Faghih M, Philipps AE, Larsen IM, et al.  Pain modulatory phenotypes differentiate chronic pancreatitis patients with distinct clinical pain profiles. Presented at: American College of Gastroenterology 2019 Annual Scientific Meeting; October 25-30, 2019; San Antonio, TX. Abstract P0935.