Erstellt am 11 Jun 2019 17:45
Zuletzt geändert: 12 Jun 2019 15:59
Leitlinien
- AWMF Leitlinie "Chronische Pankreatitis" Stand: 31.08.2012 (in Überarbeitung), gültig bis 31.08.2017! Federführend: Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten e.V. (DGVS).
Auszüge aus AWMF-Leitlinie Chronische Pankreatitis:
Andererseits kann sich auch eine exokrine Pankreasinsuffizienz, die nicht mit einer symptomatischen Steatorrhoe einhergeht, negativ auf Ernährungsparameter wie das Gewicht auswirken [89], (Evidenzgrad 2b). Zudem gibt es Studien, die eine verminderte Absorption fettlöslicher Vitamine bei Patienten mit leichter bis mäßiger exokriner Insuffizienz belegen (…) und auch neue Daten, die bei Patienten mit osteoporotischer Fraktur deutlich erniedrigte Stuhlelastase Konzentrationen nachgewiesen haben, die mit niedrigen Vitamin D3-Spiegeln korrelieren (Evidenzgrad 3b). Patienten mit Steatorrhoe waren bei dieser Untersuchung ausgeschlossen. Bereits bei subklinischer bzw. milder bis mäßiger exokriner Insuffizienz scheint also ein deutlich erhöhtes Osteoporose- und Frakturrisiko zu bestehen.
Eine exokrine Pankreas-Insuffizienz führt zur Kachexie und Folgeerkrankungen wie Vitaminmangelzuständen und der Osteoporose.
Aufgrund der Malabsorption kann es außerdem zu abdominellen Beschwerden kommen mit Diarrhoe/Steatorrhoe, abdomineller Distension / Meteorismus und Schmerzen.
- Mine T, Morizane T, Kawaguchi Y, et al. Clinical practice guideline for post-ERCP pancreatitis. J Gastroenterol. 2017 Sep;52(9):1013-1022. Springermedizin-Volltext
Lebensqualität und Langzeitfolgen der akuten Pankreatitis
- Machicado JD, Gougol A, Stello K, et al. Acute Pancreatitis Has a Long-term Deleterious Effect on Physical Health Related Quality of Life. Clin Gastroenterol Hepatol. 2017 Sep;15(9):1435-1443.e2. doi: 10.1016/j.cgh.2017.05.037.
CONCLUSIONS:
In a 14-month follow-up of patients hospitalized with AP, we found a meaningful, independent, and deleterious effect of AP in the physical HRQOL of these patients, compared to individuals without AP. Further research is needed to determine the duration of this impairment and to evaluate the effects of modifying risk factors.
- Tu J, Zhang J, Ke L, Yang Y, et al. Endocrine and exocrine pancreatic insufficiency after acute pancreatitis: long-term follow-up study. BMC Gastroenterol. 2017 Oct 27;17(1):114.
CONCLUSION:
The integrated morbidity of DM and IGT after AP was 59.25%, which was higher than exocrine pancreatic insufficiency. 6.2% and 29.2% of patients developed severe and mild to moderate exocrine pancreatic insufficiency, respectively. The extent of pancreatic necrosis>50%, WON and insulin resistance were the independent risk factors of new onset diabetes after AP.
- Umapathy C, Raina A2, Saligram S, et al. Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience. J Gastrointest Surg. 2016 Nov;20(11):1844-1853.
CONCLUSION:
ANP significantly impacts long-term survival. A high proportion of patients develop functional derangement and disability following ANP.
- Winter Gasparoto RC, Racy Mde C, De Campos T. Long-term outcomes after acute necrotizing pancreatitis: what happens to the pancreas and to the patient? JOP. 2015 Mar 20;16(2):159-66. doi: 10.6092/1590-8577/2958.
- Pendharkar SA, Salt K, Plank LD, et al. Quality of life after acute pancreatitis: a systematic review and meta-analysis. Pancreas. 2014 Nov;43(8):1194-200. doi: 10.1097/MPA.0000000000000189.
Abstract
Patient-centered outcomes, including quality of life (QoL), after acute pancreatitis (AP) remain largely unknown. Our aim was to systematically review the best available evidence on QoL after AP. English-language articles on the effect of AP on QoL were identified in MEDLINE, EMBASE, and Scopus. Results were statistically aggregated to obtain a pooled mean difference (MD) and corresponding 95% confidence interval (CI) for individual QoL domains and component summaries, where appropriate. A total of 16 prospective observational studies encompassing 687 AP patients were included. Four studies comprising 267 AP patients, as measured by SF-36 and SF-12 questionnaires, were suitable for meta-analysis. The general health and vitality domains were significantly worse in the patients compared with healthy controls (MD, -10.90; 95% CI, -15.63 to -6.17; P < 0.00001 and MD, -4.64; 95% CI, -7.32 to -1.95; P = 0.0007, respectively). The remaining individual domains and physical and mental component summary scores did not differ between patients and controls. The QoL seems to be significantly impaired in patients after AP with a need to standardize reporting on QoL. Future studies should investigate the effect of different interventions on patients' QoL.
- Appelros S, Lindgren S, Borgström A. Short and long term outcome of severe acute pancreatitis. Eur J Surg. 2001 Apr;167(4):281-6. (kein Volltext!)
OBJECTIVE:
Between 1985 and 1994, 883 cases of acute pancreatitis were treated in Malmö, Sweden (population 233,000). The purpose of this study was to report the short- and long-term outcome of the 79 cases that were severe, according to the Atlanta classification.
RESULTS:
Twenty-one patients died from their attack. Organ failure was the predominant cause of death in the 13 patients who died during the first 10 days after admission, whereas infection was the most common cause of death in patients who died later. Mortality was low under the age of 60 and increased with age. Organ failure developed in 72 patients. Twenty-four patients developed pancreatic necrosis or abscesses and 18 patients were treated by necrosectomy and open or closed drainage. At follow-up, 13 patients had died, 2 from pancreatic carcinoma. 35 patients were included in the follow-up survey. 15 of these had diabetes and an additional 4 had impaired glucose tolerance. 9 patients had signs of severe exocrine dysfunction.
CONCLUSIONS:
There was a high incidence of endocrine and exocrine dysfunction together with, in many patients, ongoing social problems related to chronic alcoholism several years after an attack of severe acute pancreatitis.
post-ERCP Pankreatitis
- Lee H, Cho CM, Heo J, et al. Impact of Hospital Volume and the Experience of the Endoscopist on Adverse Events Related to Endoscopic Retrograde Cholangiopancreatography: A Prospective Observational Study. Gut Liver. 2019 May 3. doi: 10.5009/gnl18537. [Epub ahead of print]
Conclusions:
Our study demonstrated that overall AEs following ERCP were associated with the experience of the endoscopist. To minimize post-ERCP AEs, rigorous training with a sufficient case volume is required, and treatment strategies should be modified according to the endoscopists expertise.
- Siiki A, Laukkarinen J. Can we prevent post-ERCP pancreatitis? Duodecim. 2017;133(3):267-74.
Endoscopic retrograde cholangiopancreatography (ERCP) is the primary method for treating cholestasis and biliary tract gallstones. Although noninvasive imaging has replaced ERCP in diagnostics, ERCP remains the mainstay in collecting diagnostic specimens from the biliary tract. ERCP carries a risk of post-ERCP pancreatitis, which can vary from mild to life-threatening. Difficult cannulation is the most important risk factor for pancreatitis. Careful patient selection and adequate endoscopy training are the foundation of safe ERCP practice. Current evidence supports the routine use of prophylactic rectal NSAID in all patients to prevent post-ERCP pancreatitis.
- Kochar B, Akshintala VS, Afghani E, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc. 2015 Jan;81(1):143-149.e9.
Severity of PEP was reported for 8857 patients: 5.7%, 2.6%, and 0.5% of cases were mild, moderate, and severe, respectively.
Lebensqualität nach Trauma
- Innocenti F, Del Taglia B, Coppa A, et al. Quality of life after mild to moderate trauma. Injury. 2015 May;46(5):902-8. doi: 10.1016/j.injury.2014.11.033.
CONCLUSIONS:
After a mild trauma, we evidenced a relevant reduction in HRQOL; an advanced age and a higher degree of organ dysfunction were independently associated with HRQOL deterioration.
Begleiterscheinungen
Bei wie vielen Patienten nach der akuten Pankreatitis narbige Veränderungen im Pankreasparenchym- und Pankreasgangsystem zurückbleiben, ohne dass eine chronische Pankreatitis besteht, ist zurzeit noch unbekannt:
Patientenberichte, Selbsthilfe
- Bauchspeicheldrüseninfo: Mein Leben mit einer Krankheit
- ORPHA-Selbsthilfe Foren: Chronische Pankreatitis
- TEB e.V. Selbsthilfe: Chronische Pankreatitis
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* Zitat nach: Bach, Otto: ''Über die Subjektabhängigkeit des Bildes von der Wirklichkeit im psychiatrischen Diagnostizieren und Therapieren''. In: Psychiatrie heute, Aspekte und Perspektiven, Festschrift für Rainer Tölle, Urban & Schwarzenberg, München 1994, ISBN 3-541-17181-2, (Zitat: Seite 1)
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