Advances in epidemiology and management of chronic pancreatitis

This thesis describes the first studies on chronic pancreatitis (CP) within the Dutch Pancreatitis Study Group. First, we compared diagnostic criteria for CP and identified factors that contribute to the most important discrepancies. Secondly, a survey among physicians detailed the large variation in management of CP. Subsequently, a large cohort study investigated the long-term outcome of patients with acute pancreatitis and described the rates and risk factors for recurrent pancreatitis and CP. A systematic review on antioxidant therapy in CP showed a very limited benefit, despite initial promising results. Subsequently, we focused on the optimal timing of surgery. For this, a large cohort study was performed and identified early surgery as an important factor for successful outcomes. We also showed that patients with altered pain processing had worse outcomes after pancreatic surgery. Factors resulting in altered pain processing were prolonged pain and use of opioid analgesic. A systematic review of the outcome after splanchnic denervation also identified opioid treatment as an important risk factor for failure. Based on this, we designed a randomized trial investigating the effect of early surgery versus current practice for CP (ESCAPE-trial). The trial has now been concluded, and results are expected soon. We also set-up a nationwide database for CP (CARE), that successfully recruited over 1200 patients in 3 years. A study based on CARE showed that pancreatic exocrine insufficiency is common in CP and is associated with important complaints. Methods to improve treatment were also identified.