Domínguez-Muñoz J Enrique
Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España.
Gastroenterol Hepatol. 2014 Sep;37 Suppl 3:93-7. doi: 10.1016/S0210-5705(14)70088-3.
This article summarizes some of the recent and clinically relevant advances in chronic pancreatitis. These advances mainly concern the early diagnosis of the disease, the prediction of the fibrosis degree of the gland, the evaluation of patients with asymptomatic hyperenzimemia, the medical and surgical treatment of abdominal pain and the knowledge of the natural history of the autoimmune pancreatitis. In patients with indetermined EUS findings of chronic pancreatitis, a new endoscopic ultrasound examination in the follow-up is of help to confirm or to exclude the disease. Smoking, number of relapses, results of pancreatic function tests and EUS findings allow predicting the degree of pancreatic fibrosis in patients with chronic pancreatitis. Antioxidant therapy has shown to be effective in reducing pain secondary to chronic pancreatitis, although the type and optimal dose of antioxidants remains to be elucidated. Development of intestinal bacterial overgrowth is frequent in patients with chronic pancreatitis, but its impact on symptoms is unknown and deserves further investigations. Finally, autoimmune pancreatitis relapses in about half of the patients with either type 1 or type 2 disease; relapses frequently occur within the first two years of follow-up.
本文总结了慢性胰腺炎近期一些与临床相关的进展。这些进展主要涉及疾病的早期诊断、胰腺纤维化程度的预测、无症状高酶血症患者的评估、腹痛的内科及外科治疗以及自身免疫性胰腺炎自然史的相关知识。对于慢性胰腺炎内镜超声（EUS）检查结果不确定的患者，后续进行新的内镜超声检查有助于确诊或排除该病。吸烟、复发次数、胰腺功能检查结果及EUS表现可用于预测慢性胰腺炎患者的胰腺纤维化程度。抗氧化治疗已显示对减轻慢性胰腺炎所致疼痛有效，尽管抗氧化剂的类型及最佳剂量仍有待阐明。慢性胰腺炎患者常发生肠道细菌过度生长，但其对症状的影响尚不清楚，值得进一步研究。最后，1型或2型自身免疫性胰腺炎患者中约半数会复发；复发常发生在随访的头两年内。
