Management of pain in chronic pancreatitis with emphasis on exogenous pancreatic enzymes.

Paul M Hobbs, William G Johnson, David Y Graham
{"title":"Management of pain in chronic pancreatitis with emphasis on exogenous pancreatic enzymes.","authors":"Paul M Hobbs,&nbsp;William G Johnson,&nbsp;David Y Graham","doi":"10.4292/wjgpt.v7.i3.370","DOIUrl":null,"url":null,"abstract":"<p><p>One of the most challenging issues arising in patients with chronic pancreatitis is the management of abdominal pain. Many competing theories exist to explain pancreatic pain including ductal hypertension from strictures and stones, increased interstitial pressure from glandular fibrosis, pancreatic neuritis, and ischemia. This clinical problem is superimposed on a background of reduced enzyme secretion and altered feedback mechanisms. Throughout history, investigators have used these theories to devise methods to combat chronic pancreatic pain including: Lifestyle measures, antioxidants, analgesics, administration of exogenous pancreatic enzymes, endoscopic drainage procedures, and surgical drainage and resection procedures. While the value of each modality has been debated over the years, pancreatic enzyme therapy remains a viable option. Enzyme therapy restores active enzymes to the small bowel and targets the altered feedback mechanism that lead to increased pancreatic ductal and tissue pressures, ischemia, and pain. Here, we review the mechanisms and treatments for chronic pancreatic pain with a specific focus on pancreatic enzyme replacement therapy. We also discuss different approaches to overcoming a lack of clinical response update ideas for studies needed to improve the clinical use of pancreatic enzymes to ameliorate pancreatic pain. </p>","PeriodicalId":23755,"journal":{"name":"World Journal of Gastrointestinal Pharmacology and Therapeutics","volume":"7 3","pages":"370-86"},"PeriodicalIF":0.0000,"publicationDate":"2016-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986390/pdf/WJGPT-7-370.pdf","citationCount":"20","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Gastrointestinal Pharmacology and Therapeutics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4292/wjgpt.v7.i3.370","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 20

Abstract

One of the most challenging issues arising in patients with chronic pancreatitis is the management of abdominal pain. Many competing theories exist to explain pancreatic pain including ductal hypertension from strictures and stones, increased interstitial pressure from glandular fibrosis, pancreatic neuritis, and ischemia. This clinical problem is superimposed on a background of reduced enzyme secretion and altered feedback mechanisms. Throughout history, investigators have used these theories to devise methods to combat chronic pancreatic pain including: Lifestyle measures, antioxidants, analgesics, administration of exogenous pancreatic enzymes, endoscopic drainage procedures, and surgical drainage and resection procedures. While the value of each modality has been debated over the years, pancreatic enzyme therapy remains a viable option. Enzyme therapy restores active enzymes to the small bowel and targets the altered feedback mechanism that lead to increased pancreatic ductal and tissue pressures, ischemia, and pain. Here, we review the mechanisms and treatments for chronic pancreatic pain with a specific focus on pancreatic enzyme replacement therapy. We also discuss different approaches to overcoming a lack of clinical response update ideas for studies needed to improve the clinical use of pancreatic enzymes to ameliorate pancreatic pain.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
慢性胰腺炎疼痛的管理与外源性胰酶的重点。
慢性胰腺炎患者中最具挑战性的问题之一是腹痛的管理。存在许多相互竞争的理论来解释胰腺疼痛,包括狭窄和结石引起的导管高压,腺体纤维化引起的间质压力增加,胰腺神经炎和缺血。这种临床问题叠加在酶分泌减少和反馈机制改变的背景上。纵观历史,研究人员已经使用这些理论来设计治疗慢性胰腺疼痛的方法,包括:生活方式措施、抗氧化剂、镇痛药、外源性胰腺酶的管理、内窥镜引流手术、手术引流和切除手术。虽然每种方式的价值多年来一直存在争议,但胰酶治疗仍然是一种可行的选择。酶治疗恢复小肠的活性酶,并针对改变的反馈机制,导致胰腺导管和组织压力增加,缺血和疼痛。在这里,我们回顾了慢性胰腺疼痛的机制和治疗方法,并特别关注胰腺酶替代疗法。我们还讨论了克服缺乏临床反应的不同方法,为改善临床使用胰酶来改善胰腺疼痛的研究提供了新的思路。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Effectiveness of an amino acid beverage formulation in diarrhea-predominant irritable bowel syndrome: A pragmatic real-world study Hepatitis C virus treatment with glecaprevir and pibrentasvir in patients co-prescribed carbamazepine: Three case reports. Update on the strategy for intravenous fluid treatment in acute pancreatitis. Cinnamic acid regulates the intestinal microbiome and short-chain fatty acids to treat slow transit constipation. "Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality, complications, or outcomes": Commentary.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1