Malfertheiner P, Mayer D, Büchler M, Domínguez-Muñoz J E, Schiefer B, Ditschuneit H
Department of Internal Medicine-Gastroenterology, University Hospital of Bonn, Germany.
Gut. 1995 Mar;36(3):450-4. doi: 10.1136/gut.36.3.450.
It has been suggested that pancreatic ductal hypertension, secondary to pancreatic outflow obstruction, is a cause of pain in chronic pancreatitis. This study investigated the effect of inhibiting pancreatic secretion with octreotide in chronic pancreatitis pain. Ten patients with chronic alcoholic pancreatitis and severe daily pain were included in an intraindividual double blind crossover study. All patients received octreotide (3 x 100 micrograms/day subcutaneously) and placebo (3 x 0.9% saline solution subcutaneously) for three days at random. Between both treatment phases a two day washout period was interposed. Intensity of pain (visual analogue scale) and analgesic consumption were carefully registered. Pancreatic secretion was monitored daily by measuring faecal chymotrypsin concentration. It was found that during the administration of octreotide, pancreatic secretion was strongly inhibited (faecal chymotrypsin mean (SD) 1.7 (0.6) U/g) with respect to placebo (9.6 (4.2) U/g) and washout (7.6 (3.1) U/g) periods (p < 0.001). Pain score (29.6 (4.5) v 28.7 (5.8)) and consumption of analgesics were no different during the octreotide and placebo periods. It is concluded that short term inhibition of pancreatic secretion does not result in pain relief in patients with chronic pancreatitis. This finding is in contrast with the hypothesis that outflow obstruction of pancreatic secretion with consequent ductal hypertension is an important cause of severe persistent pain in chronic pancreatitis.
有人提出，继发于胰腺流出道梗阻的胰腺导管高压是慢性胰腺炎疼痛的一个原因。本研究调查了奥曲肽抑制胰腺分泌对慢性胰腺炎疼痛的影响。10例慢性酒精性胰腺炎且每日疼痛严重的患者纳入个体内双盲交叉研究。所有患者随机接受奥曲肽（皮下注射3×100微克/天）和安慰剂（皮下注射3×0.9%盐溶液）3天。两个治疗阶段之间有一个为期2天的洗脱期。仔细记录疼痛强度（视觉模拟评分）和镇痛药消耗量。通过测量粪便糜蛋白酶浓度每日监测胰腺分泌。结果发现，与安慰剂期（9.6（4.2）U/g）和洗脱期（7.6（3.1）U/g）相比，奥曲肽给药期间胰腺分泌受到强烈抑制（粪便糜蛋白酶均值（标准差）1.7（0.6）U/g）（p<0.001）。奥曲肽期和安慰剂期的疼痛评分（29.6（4.5）对28.7（5.8））和镇痛药消耗量无差异。结论是，短期抑制胰腺分泌不会使慢性胰腺炎患者的疼痛缓解。这一发现与胰腺分泌流出道梗阻继而导致导管高压是慢性胰腺炎严重持续性疼痛的重要原因这一假设相反。
