Pancreatitis crónica

Molero Richard, Xavier

doi:10.1016/S0210-5705(08)76635-4

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Resumen

La pancreatitis crónica es una enfermedad multifactorial. Las mutaciones en el gen de la quimotripsina C pueden favorecer el desarrollo de pancreatitis crónica. El hábito de fumar es un importante factor asociado al desarrollo y evolución de la pancreatitis crónica. Es necesario categorizar los signos identificados en la ecoendoscopia a la hora de diagnosticar una pancreatitis crónica, ya que no todos tienen el mismo valor diagnóstico. La pancreatitis autoinmunitaria tiene manifestaciones clínicas más variadas que las descritas inicialmente y varían según la población estudiada. Los criterios utilizados para el diagnóstico de la pancreatitis autoinmunitaria no son del todo precisos y su tratamiento puede requerir del uso de inmunomoduladores. El tratamiento con antioxidantes tiene efectos beneficiosos a largo plazo en pacientes con pancreatitis crónica. Algunas manifestaciones clínicas en pacientes con síndrome del intestino irritable pueden tener su origen en una insuficiencia pancreática no identificada. Un estudio con cápsula endoscópica muestra que la fibrosis quística presenta signos de enteropatía en el intestino delgado.

Palabras clave:

Pancreatitis crónica

Pancreatitis autoinmunitaria

Ecoendoscopia

Antioxidantes

Fibrosis quística

Abstract

Chronic pancreatitis is a multifactorial disease. Mutations in the chymotrypsin C gene may encourage the development of chronic pancreatitis. Smoking is an important factor in the development and progression of chronic pancreatitis. The signs identified in endoscopic ultrasound should be categorized when diagnosing chronic pancreatitis, since not all have the same diagnostic value. The clinical manifestations of autoimmune pancreatitis are more varied than initially described and depend on the population studied. The criteria used for the diagnosis of autoimmune pancreatitis have not been well defined and treatment may require the use of immunomodulators. Antioxidant therapy has beneficial effects in the long term in patients with chronic pancreatitis. Some clinical manifestations found in patients with irritable bowel syndrome may be caused by unidentified pancreatic insufficiency. Capsule endoscopy shows that cystic fibrosis presents signs of small bowel enteropathy.

Key words:

Chronic pancreatitis

autoimmune pancreatitis

endoscopic ultrasound

antioxidants

cystic fibrosis

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Bibliografía

[1.]

G. Talamini, B. Vaona, C. Bassi, P. Bovo, T. Damoc, M. Mastromauro, et al.

Alcohol intake, cigarette smoking, and body mass index in patients with alcohol-associated pancreatitis.

J Clin Gastroenterol, 31 (2000), pp. 314-317

Medline

[2.]

D. Yadav, P.A. Banks, A. Slivka, D.C. Whitcomb.

Current profile of chronic pancreatitis (CP) in the USA: Is it a multifactorial disease?.

Gastroenterology, 134 (2008), pp. A228

[3.]

D. Yadav, M.M. Barmada, M.D. Bishop, M.R. O’Connell, D.C. Whitcomb.

Alcohol and smoking are independent predictors for chronic pancreatitis.

Gastroenterology, 134 (2008), pp. A226

[4.]

M. Luaces, J. Iglesias-Garcia, J. Larino-Noia, A. Alvarez-Castro, A. Lozano-Leon, E. Dominguez-Munoz.

Onset and progression of chronic pancreatitis: it is not just alcohol, but tobacco.

Gastroenterology, 134 (2008), pp. A226

[5.]

J. Rosendahl, H. Witt, R. Szmola, E. Bhatia, B. Ozsvári, O. Landt, et al.

Chymotrypsin C (CTRC) variants that diminish activity or secretion are associated with chronic pancreatitis.

Nat Genet, 40 (2008), pp. 78-82

http://dx.doi.org/10.1038/ng.2007.44 | Medline

[6.]

M. Otsuki.

Chronic pancreatitis. The problems of diagnostic criteria.

Pancreatology, 4 (2004), pp. 28-41

http://dx.doi.org/10.1159/000077066 | Medline

[7.]

M.B. Wallace, R.H. Hawes, V. Durkalski, A. Chak, S. Mallery, M.F. Catalano, et al.

The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers.

Gastrointest Endosc, 53 (2001), pp. 294-299

Medline

[8.]

M. Raimondo, M.B. Wallace.

Diagnosis of early chronic pancreatitis by endoscopic ultrasound. Are we there yet?.

JOP J Pancreas, 5 (2004), pp. 1-7

[9.]

L.V. Hernandez, A. Sahai, W.R. Brugge, M.J. Wiersema, M.F. Catalano.

Standardized weighed criteria for EUS features of chronic pancreatitis: the Rosemont classification.

Gastrointest Endosc, 67 (2008), pp. AB96-AB97

[10.]

M.F. Catalano, V. Kaul, L.V. Hernandez, J.P. Pezanoski, N.M. Guda, D. Ramasamy, et al.

Diagnosis of chronic pancreatitis (CP) by endoscopic ultrasound (EUS) –radial vs. linear endosonography (EUS).

Gastrointest Endosc, 67 (2008), pp. AB208

[11.]

J.S. Leeds, A.D. Hopper, S. Morely, D.P. Hurlstone, D.S. Sanders.

The relationship between exocrine pancreatic hypofunction and patients fulfilling the ROME II criteria for irritable bowel syndrome.

Gastroenterology, 134 (2008), pp. A223

[12.]

A. Saftoiu, P. Vilmann, F. Gorunescu, D.I. Ghonea, M. Gorenescu, T. Ciurea, et al.

Neural network análisis of dinamic sequences of EUS elastography used for the differential diagnosis of chronic pancreatitis and pancreatic cancer.

Gastrointest Endosc, 67 (2008), pp. AB97

[13.]

T.Y. Lee, M.H. Kim, J.Y. Kim, S.S. Lee, D.W. Seo, S.k. Lee, et al.

Clinical role of FDG-PET in autoinmune chronic pancreatitis.

Gastroenterology, 134 (2008), pp. A223

[14.]

K. Kim, M.H. Kim, M.H. Song, S.S. Lee, D.W. Seo, S.K. Lee.

Autoimmune chronic pancreatitis.

Am J Gastroenterol, 99 (2004), pp. 1605-1616

http://dx.doi.org/10.1111/j.1572-0241.2004.30336.x | Medline

[15.]

D.L. Finkelberg, D. Sahani, V. Deshpande, W.R. Brugge.

Autoimmune pancreatitis.

N Engl J Med, 355 (2006), pp. 2670-2676

http://dx.doi.org/10.1056/NEJMra061200 | Medline

[16.]

S. Kwon, M.H. Kim, E.K. Choi.

The diagnostic criteria for autoimmune chronic pancreatitis: it is time to make a consensus.

Pancreas, 34 (2007), pp. 279-286

http://dx.doi.org/10.1097/MPA.0b013e31802eff5f | Medline

[17.]

L. Aparisi, A. Farre, L. Gomez-Cambronero, J. Martinez, G. De Las Heras, J. Corts, et al.

Antibodies to carbonic anhydrase and IgG4 levels in idiopathic chronic pancreatitis: relevance for diagnosis of autoimmune pancreatitis.

Gut, 54 (2005), pp. 703-709

http://dx.doi.org/10.1136/gut.2004.047142 | Medline

[18.]

K. Okazaki, S. Kawa, T. Kamisawa, et al.

Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal.

J Gastroenterol, 41 (2006), pp. 626-631

http://dx.doi.org/10.1007/s00535-006-1868-0 | Medline

[19.]

S.T. Chari, T.C. Smyrk, M.J. Levy, et al.

Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience.

Clin Gastroenterol Hepatol, 4 (2006), pp. 1010-1016

http://dx.doi.org/10.1016/j.cgh.2006.05.017 | Medline

[20.]

K. Okazaki, S. Kawa, T. Kamisawa, S. Naruse, S. Tanaka, I. Nishimori, Research Committee of Intractable Diseases of the Pancreas, et al.

Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal.

J Gastroenterol, 41 (2006), pp. 626-631

http://dx.doi.org/10.1007/s00535-006-1868-0 | Medline

[21.]

S.A. Giday, J.M. Buscaglia, D.M. Krishnamurty, T. Chen, A.N. Kalloo, M.I. Canto, et al.

Autoimmune pancreatitis: application of current diagnostic criteria are suboptimal.

Gastroenterology, 134 (2008), pp. A226

[22.]

F. Kasmin, A. Cooperman, S.A. Cohen, M. Wayne, W.H. Brown, J.H. Siegel.

Seronegative autoinmune pancreatitis: a commonly missed diagnosis in US patients?.

Gastroenterology, 134 (2008), pp. A227

[23.]

T. Kamisawa, N. Egawa, K. Tsuruta, A. Okamoto.

Comparison between biliary lesions associated with autoinmune pancreatitis and primary sclerosing cholangitis.

Gastroenterology, 134 (2008), pp. A225

[24.]

V. Rebours, M.C. Boutron-Ruault, M. Schnee, C. Férec, F. Maire, P. Hammel, et al.

Risk of pancreatic adenocarcinoma in patients with hereditary pancreatitis: a national exhaustive series.

Am J Gastroenterol, 103 (2008), pp. 111-119

http://dx.doi.org/10.1111/j.1572-0241.2007.01597.x | Medline

[25.]

V. Rebours, M.C. Boutron-Ruault, V. Jooste, A.M. Bouvier, A. Apch, P. Hammel, et al.

Mortality rate in patients with hereditary pancreatitis (HP) compared with the French general population.

Gastroenterology, 134 (2008), pp. A10

[26.]

L. Frulloni, C. Scattolini, G. Zamboni, S. Manfredi, A. Amodio, F. Iorio, et al.

Long term follow-up of autoinmune pancreatitis in Italy.

Gastroenterology, 134 (2008), pp. A225

[27.]

M. Wilschanski, Y. Yaakov, G. Stern, D. Shoseyov, J. Rivlin, L. Bentur, et al.

Intestinal current measurement as a diagnostic procedure in cystic fibrosis in infants and young children.

Gastroenterology, 134 (2008), pp. A10

[28.]

S. Werlin, I. Benuri-Silbiger, L. Cohen, N. Malka, E. Kerem, M. Aviram, et al.

Enteropathy. A new finding in cystic fibrosis.

Gastroenterology, 134 (2008), pp. A142

[29.]

R. Houwen, H. Van der Doef, I. Sermet, A. Munck, B. Hauser, J. Walkowiak, et al.

Defining distal intestinal obstruction syndrome (DIOS) and constipation in cystic fibrosis: a multicenter study on the incidente, characteristics and treatment of DIOS.

Gastroenterology, 134 (2008), pp. A229

[31.]

N. Shah, A.J. Sheen, A.K. Siriwardena.

Comparative study of quality of life in patients on long-term anti-oxidant (antox) therapy for painful chronic pancreatitis.

Gastroenterology, 134 (2008), pp. A225

[31.]

S. Duggan, S.M. Egan, K.C. Conlon.

Vitamin D deficiency and low bone density are common in patients with chronic pancreatitis.

Gastroenterology, 134 (2008), pp. A749

[32.]

D. Conwell, A.S. Tignor, K. Repas, B.U. Wu, M. Leboff, P. Banks.

There is a high prevalence and association of osteopenia in chronic pancreatitis (CP) patients referred for Dexa Scan.

Gastroenterology, 134 (2008), pp. A223

[33.]

N.S. Sandanayake, A.R. Hatfield, S.P. Pereira, G.J. Webster.

Azathioprine in the management of relapsing autoinmune pancreatitis/IgG4 sclerosing cholangitis.

Gastroenterology, 134 (2008), pp. A11

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