Natural Course of Abdominal Pain in Chronic Pancreatitis with Intermittent (Type A) Pain after Conservative Treatment
Supot Pongprasobchai MD*, Sathaporn Manatsathit MD*
Affiliation : * Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Bangkok, Thailand
Background : Abdominal pain in chronic pancreatitis (CP) is difficult to treat and appropriate choice of
treatment is controversial. It has been suggested that patients with CP, particularly from alcohol (ACP) with
intermittent attack of abdominal pain (type A pain) should be managed conservatively because pain relief
will be achieved in most cases. However, data of the efficacy of this strategy is scanty and conflicting and
whether this strategy is effective or feasible in idiopathic CP (ICP) is unclear.
Material and Method: Data of all patients with CP with type A pain, who were followed-up and managed
conservatively during 2004-2008 were analyzed. Pain relief was defined by the absence of abdominal pain for
more than 1 year.
Results : Twenty-two patients were followed-up with a median duration of 31 months (range 5-96 months). The
etiology of CP was alcoholic (ACP) in 12 (56%), early-onset idiopathic (E-ICP) in 5 (22%) and late-onset
idiopathic (L-ICP) in 5 (22%). Alcohol abstinence was successful in every ACP patient. Overall, 18 patients
(82%) had pain relief with a median duration of 39 months (range 16-167 months) from the onset of pain or
14 months (range 11-57 months) from the time of diagnosis of CP. Pain relief was achieved at a higher level
mainly in ACP (100%) and L-ICP (80%) but was only 40% in E-ICP. Median duration from onset until pain
relief were 28 months (range 16-167 months) for ACP, 36 months (range 16-39 months) for L-ICP and 120
months (range 42-120 months) for E-ICP. The difference was statistically significant between L-ICP and E-ICP
(p = 0.036), but not between ACP and E-ICP (p = 0.13) and between ACP and L-ICP (p = 0.80). Median
duration from the time of diagnosis of CP until pain relief was only 14 months for ACP, 13 months for L-ICP, but
was 52 months for E-ICP. None of the patients required narcotics, endoscopic therapy or surgery.
Conclusion : Conservative management was feasible and effective in most patients with CP and type A pain,
particularly ACP after alcohol abstinence, and L-ICP. Conservative treatment was not effective in E-ICP.
Keywords : Abdominal pain, Chronic disease, Pain measurement, Pancreatitis
