Rupjyoti Talukdar, D Nageshwar Reddy, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, Hyderabad 500082, India.
World J Gastroenterol. 2013 Oct 14;19(38):6319-28. doi: 10.3748/wjg.v19.i38.6319.
Chronic pancreatitis (CP) continues to be a clinical challenge. Persistent or recurrent abdominal pain is the most compelling symptom that drives patients to seek medical care. Unfortunately, in spite of using several treatment approaches in the clinical setting, there is no single specific treatment modality that can be earmarked as a cure for this disease. Traditionally, ductal hypertension has been associated with causation of pain in CP; and patients are often subjected to endotherapy and surgery with a goal to decompress the pancreatic duct. Recent studies on humans (clinical and laboratory based) and experimental models have put forward several mechanisms, including neuroimmune alterations, which could be responsible for pain. This might explain the partial or no response to single modality treatment in a significant proportion of patients. The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches (other than ductal decompression) to handle persistent or recurrent pain. We focus primarily on parenchymal and neural components; and discuss the role of antioxidants and the existing controversies, drugs that interfere with neural transmission, pancreatic enzyme supplementation, celiac neurolysis, and pancreatic resection procedures. The review concludes with the treatment approach that we follow at our institute.
慢性胰腺炎（CP）仍然是一个临床挑战。持续性或复发性腹痛是最引人注目的症状，促使患者寻求医疗。不幸的是，尽管在临床环境中使用了几种治疗方法，但没有一种单一的特定治疗方法可以被指定为这种疾病的治愈方法。传统上，胰管高压与 CP 疼痛的发生有关；患者经常接受内镜治疗和手术，以达到胰管减压的目的。最近对人类（临床和实验室）和实验模型的研究提出了几种机制，包括神经免疫改变，这些机制可能与疼痛有关。这可能解释了相当一部分患者对单一治疗方法的部分或无反应。这篇综述讨论了 CP 中疼痛产生的最新概念和循证治疗方法（除了胰管减压）来处理持续性或复发性疼痛。我们主要关注实质和神经成分；并讨论抗氧化剂的作用和现有争议，干扰神经传递的药物，胰酶补充，腹腔神经松解术，和胰腺切除术。该综述以我们在研究所遵循的治疗方法结束。
