Clinical Course of Chronic Pancreatitis in Elderly Patients

被引：6

作者：

Hirth, Michael ^{[1
]}

Haertel, Nicolai ^{[1
]}

Weiss, Christel ^{[2
]}

Hardt, Philip ^{[3
]}

Gubergrits, Natalia ^{[4
]}

Ebert, Matthias P. ^{[1
]}

Schneider, Alexander ^{[1
]}

机构：

[1] Heidelberg Univ, Dept Med 2, Univ Med Ctr Mannheim, Med Fac Mannheim, Mannheim, Germany

[2] Heidelberg Univ, Med Stat, Univ Med Ctr Mannheim, Med Fac Mannheim, Mannheim, Germany

[3] Univ Hosp Giessen, Cent Interdiciplinary Visceral Med & Endoscopy, Giessen, Germany

[4] Donetsk Natl Med Univ, Dept Internal Med, Donetsk, Ukraine

来源：

DIGESTION | 2019年 / 100卷 / 03期

关键词：

Chronic pancreatitis; Elderly; M-ANNHEIM classification; Pain; CANCER AMERICAN SOCIETY; EARLY-ONSET; GUIDELINES; MANAGEMENT; VARIANTS;

D O I：

10.1159/000494349

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background: Several guidelines recommend the risk-adapted monitoring of patients with chronic pancreatitis (CP). However, dedicated risk stratification is widely missing in CP. Elderly-CP (disease onset with 60 or more years of age) may represent a subgroup of CP subjects with a distinct course of disease. Aims: We aimed to investigate the clinical presentation of elderly-CP, and if elderly-CP requires an adapted monitoring. Methods: Seven hundred forty one patients with CP were analyzed in a multicenter (Mannheim/Germany, n = 537; Gie ss en/Germany, n = 100; Donetsk/Ukraine, n = 104), cross-sectional, retrospective study and classified according to the M-ANNHEIM classification. Results: The frequency of elderly-CP was 20% (148/741). In comparison with non-elderly-CP, elderly-CP was less frequently caused by alcohol and nicotine dependency or genetic mutations. In contrast, the frequency of efferent duct abnormalities (p = 0.009, chi-square test) and idiopathic CP (p < 0.0001, chi-square test) increased significantly. The presence of multiple risk factors was found less frequently in elderly-CP than in non-elderly patients (p < 0.0001; chi-square test). Furthermore, elderly-CP was associated with increased rates of pseudocysts (p = 0.0002; chi-square test), endocrine insufficiency (p = 0.001; chi-square test), and the absence of pain (p = 0.04; chi-square test) in the first year of the disease. Conclusion: In elderly-CP, the course of disease significantly differs from non-elderly-CP. Therefore, individualized monitoring strategies for elderly-CP might be necessary.

引用

页码：152 / 159

页数：8

共 29 条

[1] Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis [J].

Aghdassi, Ali ;

Mayerle, Julia ;

Kraft, Matthias ;

Sielenkaemper, Andreas W. ;

Heidecke, Claus-Dieter ;

Lerch, Markus M. .

PANCREAS, 2008, 36 (02) :105-112

[2] Clinical Outcome in Relation to Timing of Surgery in Chronic Pancreatitis A Nomogram to Predict Pain Relief [J].

Ali, Usama Ahmed ;

Nieuwenhuijs, Vincent B. ;

van Eijck, Casper H. ;

Gooszen, Hein G. ;

van Dam, Ronald M. ;

Busch, Olivier R. ;

Dijkgraaf, Marcel G. W. ;

Mauritz, Femke A. ;

Jens, Sjoerd ;

Mast, Jay ;

van Goor, Harry ;

Boermeester, Marja A. .

ARCHIVES OF SURGERY, 2012, 147 (10) :925-932

[3]

AMMANN RW, 1990, GASTROENTEROL CLIN N, V19, P905

[4] Locally Advanced, Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline [J].

Balaban, Edward P. ;

Mangu, Pamela B. ;

Khorana, Alok A. ;

Shah, Manish A. ;

Mukherjee, Somnath ;

Crane, Christopher H. ;

Javle, Milind M. ;

Eads, Jennifer R. ;

Allen, Peter ;

Ko, Andrew H. ;

Engebretson, Anitra ;

Herman, Joseph M. ;

Strickler, John H. ;

Benson, Al B., III ;

Urba, Susan ;

Yee, Nelson S. .

JOURNAL OF CLINICAL ONCOLOGY, 2016, 34 (22) :2654-U169

[5] Management of Chronic Pancreatitis [J].

Forsmark, Christopher E. .

GASTROENTEROLOGY, 2013, 144 (06) :1282-+

[6] Genetic Risk in Chronic Pancreatitis: The Trypsin-Dependent Pathway [J].

Hegyi, Eszter ;

Sahin-Toth, Miklos .

DIGESTIVE DISEASES AND SCIENCES, 2017, 62 (07) :1692-1701

[7] CFTR: A New Horizon in the Pathomechanism and Treatment of Pancreatitis [J].

Hegyi, Peter ;

Wilschanski, Michael ;

Muallem, Shmuel ;

Lukacs, Gergely L. ;

Sahin-Toth, Miklos ;

Uc, Aliye ;

Gray, Michael A. ;

Rakonczay, Zoltan, Jr. ;

Maleth, Jozsef .

REVIEWS OF PHYSIOLOGY, BIOCHEMISTRY AND PHARMACOLOGY, VOL 170, 2016, 170 :37-66

[8] English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis [J].

Hoffmeister, A. ;

Mayerle, J. ;

Beglinger, C. ;

Buechler, M. W. ;

Bufler, P. ;

Dathe, K. ;

Foelsch, U. R. ;

Friess, H. ;

Izbicki, J. ;

Kahl, S. ;

Klar, E. ;

Keller, J. ;

Knoefel, W. T. ;

Layer, P. ;

Loehr, M. ;

Meier, R. ;

Riemann, J. F. ;

Ruenzi, M. ;

Schmid, R. M. ;

Schreyer, A. ;

Tribl, B. ;

Werner, J. ;

Witt, H. ;

Moessner, J. ;

Lerch, M. M. .

ZEITSCHRIFT FUR GASTROENTEROLOGIE, 2015, 53 (12) :1447-1495

[9] Evidence-based clinical practice guidelines for chronic pancreatitis 2015 [J].

Ito, Tetsuhide ;

Ishiguro, Hiroshi ;

Ohara, Hirotaka ;

Kamisawa, Terumi ;

Sakagami, Junichi ;

Sata, Naohiro ;

Takeyama, Yoshifumi ;

Hirota, Morihisa ;

Miyakawa, Hiroyuki ;

Igarashi, Hisato ;

Lee, Lingaku ;

Fujiyama, Takashi ;

Hijioka, Masayuki ;

Ueda, Keijiro ;

Tachibana, Yuichi ;

Sogame, Yoshio ;

Yasuda, Hiroaki ;

Kato, Ryusuke ;

Kataoka, Keisho ;

Shiratori, Keiko ;

Sugiyama, Masanori ;

Okazaki, Kazuichi ;

Kawa, Shigeyuki ;

Tando, Yusuke ;

Kinoshita, Yoshikazu ;

Watanabe, Mamoru ;

Shimosegawa, Tooru .

JOURNAL OF GASTROENTEROLOGY, 2016, 51 (02) :85-92

[10] Chronic pancreatitis in the elderly in Japan [J].

Kamisawa, T ;

Yoshiike, M ;

Egawa, N ;

Nakajima, H ;

Tsuruta, K ;

Okamoto, A ;

Nakamura, T .

PANCREATOLOGY, 2004, 4 (3-4) :223-227

← 1 2 3 →