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Palliation of pain in chronic pancreatitis. Use of enzymes.

Abstract
According to the concept of negative feedback regulation of pancreatic enzyme secretion by proteases, treatment with pancreatic extracts has been proposed to lower pain in chronic pancreatitis by decreasing pancreatic duct pressure. The author, however, has demonstrated in healthy volunteers that intraduodenal application of porcine pancreatic extracts does not inhibit but rather stimulates pancreatic enzyme secretion. This is probably because of the high-protein content of porcine pancreatic extracts that may overwhelm a potential inhibitory effect of proteases. In a prospective placebo-controlled, double-blind multicenter study to investigate the effect of acid-protected porcine pancreatic extracts on pain in 43 patients with chronic pancreatitis, pain improved in most patients regardless of whether they started with placebo or verum. There was no significant difference between both treatment arms. In a meta-analysis, which included the author's study, six randomized, double-blind, placebo-controlled studies were evaluated. Statistical analysis demonstrated no benefit of the application of porcine pancreatic extracts to relieve pain in chronic pancreatitis. The author concluded that pancreatic extracts neither inhibit pancreatic enzyme secretion nor are they efficient in lowering pain in chronic pancreatitis.
AuthorsJ Mössner
JournalThe Surgical clinics of North America (Surg Clin North Am) Vol. 79 Issue 4 Pg. 861-72, xi (Aug 1999) ISSN: 0039-6109 [Print] United States
PMID10470332 (Publication Type: Journal Article, Review)
Chemical References
  • Pancreatic Extracts
  • Cholecystokinin
Topics
  • Animals
  • Cholecystokinin (metabolism)
  • Chronic Disease
  • Feedback
  • Humans
  • Pain (etiology, prevention & control)
  • Pancreatic Extracts (therapeutic use)
  • Pancreatitis (complications, drug therapy, metabolism)

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