Clinical course and prognosis of medically managed patients with small vs. large duct chronic pancreatitis
Author
Mahdi, Marco Bassam
Term
5. Term (Master thesis)
Education
Publication year
2022
Submitted on
2022-01-05
Pages
11
Abstract
Kronisk pankreatitis er en langvarig betændelsestilstand i bugspytkirtlen. Den kan inddeles i small duct og large duct ud fra størrelsen og udseendet af bugspytkirtlens udførselsgang på scanninger. Der findes kun få data om, hvordan disse to typer klarer sig over tid, når de behandles medicinsk (uden operation). Vi undersøgte den samlede dødelighed og udviklingen i bugspytkirtlens hormonfunktion (endokrin; fx blodsukker/diabetes) og fordøjelsesfunktion (eksokrin; produktion af fordøjelsesenzymer) hos 198 patienter med sikkert diagnosticeret kronisk pankreatitis. Patienterne blev grupperet efter gangstørrelse, og vi sammenlignede risikoen for død, nyopstået diabetes og eksokrin pankreasinsufficiens. Hos en undergruppe med kontrolscanninger målte vi også ændringer i bugspytkirtlens størrelse og gangens udseende over tid. Resultaterne viste, at gennemsnitsalderen var 58 år, og 70% var mænd. 38% havde large duct sygdom, og 62% havde small duct. Over fem år var dødeligheden og forekomsten af nyopstået diabetes ens mellem grupperne. Derimod havde patienter med large duct sygdom en højere risiko for at udvikle eksokrin pankreasinsufficiens, hvilket kan give problemer med at fordøje mad på grund af mangel på enzymer. De havde også mere tab af bugspytkirtelvæv (atrofi), især i bugspytkirtlens hoved. Blandt dem med opfølgende scanninger ændrede 14% gangmorfologi over tid, og de fleste af disse udviklede large duct sygdom. Konklusion: Ved medicinsk behandling er large duct kronisk pankreatitis forbundet med en øget risiko for fordøjelsesenzymsvigt og skrumpning af bugspytkirtlen sammenlignet med small duct, mens overlevelse og risiko for nyopstået diabetes er tilsvarende i de to grupper.
Chronic pancreatitis is a long-lasting inflammation of the pancreas. It can be grouped into small duct and large duct disease based on how the main pancreatic duct looks on imaging. There is limited information on how these two types fare over time when managed medically (without surgery). We examined overall mortality and changes in the pancreas’s hormone function (endocrine; e.g., blood sugar/diabetes) and digestive function (exocrine; production of digestive enzymes) in 198 patients with confirmed chronic pancreatitis. Patients were grouped by duct size, and we compared the risks of death, new-onset diabetes, and exocrine pancreatic insufficiency. In a subgroup with follow-up scans, we also measured changes in pancreatic size and duct appearance over time. Results showed an average age of 58 years and 70% men; 38% had large duct disease and 62% had small duct disease. Over five years, death rates and new-onset diabetes were similar between groups. In contrast, patients with large duct disease had a higher risk of developing exocrine pancreatic insufficiency, which can cause difficulty digesting food due to lack of enzymes. They also had greater loss of pancreatic tissue (atrophy), especially in the head of the pancreas. Among those with repeat imaging, 14% changed duct morphology over time, and most of these progressed to large duct disease. Conclusion: In medically managed chronic pancreatitis, large duct disease carries a higher risk of digestive enzyme failure and pancreatic atrophy compared with small duct disease, while survival and new diabetes rates are similar.
[This summary has been rewritten with the help of AI based on the project's original abstract]
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