Pancreatitis crónica para el clínico. Parte 1: Etiología y Diagnóstico. Documento de posicionamiento interdisciplinar de la Societat Catalana de Digestologia y la Societat Catalana de Pàncrees (versión castellana).

Published on Jun 19, 2021in Gastroenterología y Hepatología2.102
· DOI :10.1016/J.GASTROHEP.2021.05.017
Xavier Molero20
Estimated H-index: 20
,
Juan Ramón Ayuso16
Estimated H-index: 16
+ 18 AuthorsEsther Fort3
Estimated H-index: 3
Sources
Abstract
Resumen null null La pancreatitis cronica es una enfermedad fibroinflamatoria del pancreas originada por accion combinada de factores etiologicos. Muestra formas de presentacion, tipos de complicaciones y grados evolutivos variables. Las opciones terapeuticas son tan diversas como los multiples escenarios clinicos. Algunas sociedades medicas han desarrollado guias sobre diagnostico y tratamiento basadas en evidencia cientifica. Pero la elevada variabilidad que conforman la conjuncion de elementos etiologicos, presentaciones clinicas, complicaciones y progresion de la enfermedad hace que los niveles de evidencia obtenidos sean generalmente bajos y, por tanto, las recomendaciones tienden a ser vagas o debiles, salvo excepciones.En los presentes documentos de posicionamiento de la Societat Catalana de Digestologia y la Societat Catalana de Pancrees hemos buscado redactar declaraciones bien definidas orientadas al clinico, basadas en revisiones actualizadas de literatura y acuerdos de expertos. El objetivo es proponer el uso de terminologia comun y circuitos diagnostico/terapeuticos racionales basados en el conocimiento actual. Para este fin se revisaron 51 secciones relacionadas con pancreatitis cronica por 21 expertos de 6 especialidades diferentes para generar finalmente 88 declaraciones que buscan armonizar conceptos y formular recomendaciones precisas.La parte 1 de esta serie de documentos discute topicos sobre etiologia, diagnostico y diagnostico diferencial. Factores etiologicos de mayor relevancia son toxicos (alcohol y tabaco), geneticos y obstructivos. Dolor abdominal, insuficiencia exocrina y endocrina y sintomas derivados de complicaciones son las presentaciones mas frecuentes. Algunos pacientes permanecen asintomaticos. El diagnostico (seguro, probable o incierto) debe sustentarse en datos objetivos obtenidos en pruebas de imagen, histologia y pruebas de funcion pancreatica.
References142
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#1Xavier Molero (ISCIII: Carlos III Health Institute)H-Index: 1
#2Juan Ramón AyusoH-Index: 16
Last. Eva Cristina Vaquero (ISCIII: Carlos III Health Institute)H-Index: 1
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Abstract Background Painless chronic pancreatitis (CP) is a rare form of the disease. Aim To evaluate the prevalence and the characteristics of this overlooked form of pancreatitis. Methods Patients with a diagnosis of CP and absence of pain were selected, excluding patients suffering from autoimmune pancreatitis. Clinical data, imaging features, and exocrine and endocrine function were therefore analyzed. Results Among 781 patients observed between 2010 and 2016, 74 patients with painless CP (9...
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#1Wolfgang SchimaH-Index: 55
#2Gernot BöhmH-Index: 3
Last. Helmut KopfH-Index: 1
view all 6 authors...
Various inflammatory abnormalities of the pancreas can mimic pancreatic ductal adenocarcinoma (PDAC) at cross-sectional imaging. Misdiagnosis of PDAC at imaging may lead to unnecessary surgery. On the other hand, chronic pancreatitis (CP) bears a greater risk of developing PDAC during the course of the disease. Thus, differentiation between mass-forming chronic pancreatitis (MFCP) and PDAC is important to avoid unnecessary surgery and not to delay surgery of synchronous PDAC in CP. Imaging featu...
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#1William Greenhalf (University of Liverpool)H-Index: 50
#2Philippe Lévy (University of Paris)H-Index: 14
Last. John P. Neoptolemos (Heidelberg University)H-Index: 127
view all 26 authors...
Abstract Background Patients with chronic pancreatitis (CP) have an increased risk of pancreatic cancer. We present the international consensus guidelines for surveillance of pancreatic cancer in CP. Methods The international group evaluated 10 statements generated from evidence on 5 questions relating to pancreatic cancer in CP. The GRADE approach was used to evaluate the level of evidence available per statement. The working group voted on each statement for strength of agreement, using a nine...
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#1Atsushi Masamune (Tohoku University)H-Index: 70
#2Hiroshi Kotani (LMB: Laboratory of Molecular Biology)H-Index: 2
Last. Tooru ShimosegawaH-Index: 94
view all 45 authors...
Abstract Background and Aims Changes in pancreatic calcium levels affect secretion and might be involved in development of chronic pancreatitis (CP). We investigated the association of CP with the transient receptor potential cation channel subfamily V member 6 gene (TRPV6), which encodes a Ca2+-selective ion channel, in an international cohort of patients and in mice. Methods We performed whole-exome sequencing DNA from a patient with idiopathic CP and from his parents, who did not have CP. We ...
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#9Liang Li (University of Texas MD Anderson Cancer Center)H-Index: 7
PURPOSE: Determine inter-observer variability among radiologists in assigning Cambridge Classification (CC) of chronic pancreatitis (CP) based on magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) and contrast-enhanced CT (CECT). METHODS: Among 422 eligible subjects enrolled into the PROCEED study between 6/2017 and 8/2018, 39 were selected randomly for this study (chronic abdominal pain (n = 8; CC of 0), suspected CP (n = 22; CC of 0, 1 or 2) or definite CP (n =...
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#1Irene Esposito (HHU: University of Düsseldorf)H-Index: 71
#2Ralph H. Hruban (Johns Hopkins University)H-Index: 213
Last. Fiona Campbell (RLUH: Royal Liverpool University Hospital)H-Index: 31
view all 20 authors...
Abstract Background Chronic pancreatitis is a complex multifactorial fibro-inflammatory disease. Consensus guidelines are needed for the histopathological evaluation of non-autoimmune chronic pancreatitis (CP). Methods An international working group with experts on the histopathology of CP evaluated 15 statements generated from evidence on seven key clinically relevant questions. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the leve...
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#1Maisam Abu-El-Haija (UC: University of Cincinnati)H-Index: 21
#2Takayuki Anazawa (Kyoto University)H-Index: 19
Last. Melena D. Bellin (UMN: University of Minnesota)H-Index: 42
view all 22 authors...
Abstract Background Advances in our understanding of total pancreatectomy with islet autotransplantation (TPIAT) have been made. We aimed to define indications and outcomes of TPIAT. Methods Expert physician-scientists from North America, Asia, and Europe reviewed the literature to address six questions selected by the writing group as high priority topics. A consensus was reached by voting on statements generated from the review. Results Consensus statements were voted upon with strong agreemen...
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#21David C. Whitcomb (University of Pittsburgh)H-Index: 91
Abstract Background Chronic pancreatitis (CP) is a complex inflammatory disease with remarkably impaired quality of life and permanent damage of the pancreas. This paper is part of the international consensus guidelines on CP and presents the consensus on factors elevating the risk for CP. Methods An international working group with 20 experts on CP from the major pancreas societies (IAP, APA, JPS, and EPC) evaluated 14 statements generated from evidence on four questions deemed to be the most c...
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#1Marinus A. Kempeneers (UvA: University of Amsterdam)H-Index: 5
#2Y. Issa (UvA: University of Amsterdam)H-Index: 11
Last. Marja A. Boermeester (UvA: University of Amsterdam)H-Index: 5
view all 19 authors...
Abstract Background/objectives Chronic pancreatitis (CP) is a complex inflammatory disease with pain as the predominant symptom. Pain relief can be achieved using invasive interventions such as endoscopy and surgery. This paper is part of the international consensus guidelines on CP and presents the consensus guideline for surgery and timing of intervention in CP. Methods An international working group with 15 experts on CP surgery from the major pancreas societies (IAP, APA, JPS, and EPC) evalu...
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