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International Journal of Pancreatology

, Volume 6, Issue 2, pp 139–150 | Cite as

Pancreatic calcifications in patients with chronic pancreatitis

A sign of long-lasting or severe disease?
  • Ludovico A. Scuro
  • Giorgio Cavallini
  • Luigi Benini
  • Giorgio Brocco
  • Paolo Bovo
  • Andreina Riela
  • Michele Togni
  • Giovanni Cataudella
  • Claudio Bassi
  • Paolo Pederzoli
  • Rocco Micciolo
Article
  • 16 Downloads

Summary

Pancreatic calcifications are particularly frequent in patients with severe pancreatic insufficiency and long-lasting chronic pancreatitis. To clarify whether calcifications point to a more severe form of the disease, irrespective of its duration, we have retrospectively analyzed patients with chronic pancreatitis submitted to the secretin-cerulein test in our center over a six-year period. Out of 120 patients, calcifications were found in 55. Higher alcohol intake and longer duration of the disease were found in patients with calcifications, compared with patients without calcifications (p< 0.001). In both groups, lipase and chymotrypsin were more severely impaired than bicarbonate; a greater reduction of pancreatic exocrine function was found in patients with calcifications, compared to those without (p< 0.001, Mann-Whitney U-test). When the patients were classified according to the duration of the disease or the severity of exocrine function impairment, higher percentages of patients with calcifications were found in the classes with more advanced disease. A log-linear analysis showed that the prevalence of calcifications was associated with pancreatic function impairment, even within the same class of duration of the disease. It is likely that calcifications mark more severe forms of chronic pancreatitis, even in the early phases of the disease.

Key Words

Pancreatic calcifications chronic pancreatitis long-lasting chronic pancreatitis severe pancreatic function 

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References

  1. 1.
    Edmonson HA, Bullock WK, Mehl SW. Chronic pancreatitis and lithiasis. II. Pathology and pathogenesis of pancreatic lithiasis. Am. J. Pathol. 1949; 26: 37–49.Google Scholar
  2. 2.
    Owens JL, Howard JM. Pancreatic calcification: a late sequel in the natural history of chronic alcoholism and alcoholic pancreatitis. Ann. Surg. 1958; 147: 326–338.PubMedCrossRefGoogle Scholar
  3. 3.
    Toskes PP, Greenberger NJ. Acute and chronic pancreatitis. DM-Disease-a-Month 1983; 29: 1–81.Google Scholar
  4. 4.
    Creutzfeldt W, Fehr H, Schmidt H. Verlaufsbeobachtungen und diagnostiche Verfahren bei der chronisch-rezidividierendenund chronischen Pankreatitis. Schweitz Med. Wochenschr. 1970; 100: 1180–1189.Google Scholar
  5. 5.
    Ammann RW, Hammer B, Fumagalli I. Chronic pancreatitis in Zurich, 1963– 1977. Clinical findings and follow-up studies in 102 cases. Digestion 1973; 9: 404–415.PubMedGoogle Scholar
  6. 6.
    Sarles H. Chronic calcifying pancreatitis-chronic alcoholic pancreatitis. Gastroenterology 1974; 66: 604–616.PubMedGoogle Scholar
  7. 7.
    Vantini I, Piubello W, Cavallini G, Ederle A, Benini L, Scuro LA. Chronic pancreatitis in North-East Italy: a clinical and pathological study. Acta Hepato-gastroenterol. 1978; 25: 130–135.Google Scholar
  8. 8.
    Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology 1984; 86: 820–828.PubMedGoogle Scholar
  9. 9.
    Bernades P, Belghiti J, Athouel M, Mallardo N, Breil P, Fekete F. Histoire naturelle de la pancreatite chronique: etude de 120 cas. Gastroenterol. Clin. Biol. 1983; 7: 8–13.PubMedGoogle Scholar
  10. 10.
    DiMagno EP, Clain JE. The exocrine pancreas: biology, pathobiology, and diseases, Chronic Pancreatitis, Go VLW, Gardner JD, Brooks FP, Lebenthal E, DiMagno EP, Scheele GA, eds., Raven, New York 1986; 541–575.Google Scholar
  11. 11.
    Sarles H, Sahel J, Staub JL, Bourry J, Laugier R. The exocrine pancreas. Chronic pancreatitis, Howat HT, Sarles H, eds., WB Saunders, Philadelphia, 1979; 402–439.Google Scholar
  12. 12.
    Lankish PG, Otto J, Erkelenz I, Lembcke B. Pancreatic calcifications: no indicator of severe exocrine pancreatic insufficiency. Gastroenterology 1986; 90: 617–621.0Google Scholar
  13. 13.
    Axon ATR, Classen M, Cotton PB, Cremer M, Freeny PC, Lees WR. Pancreatography in chronic pancreatitis: international definitions. Gut. 1984; 25: 1107–1112.PubMedCrossRefGoogle Scholar
  14. 14.
    Cavallini G, Mirachian R, Angelini G, Vantini I, Vaona B, Bovo P, Gelpi F, Ederle A, Dobrilla G, Scuro LA. The role of caerulein in tests of exocrine pancreatic function. Scand. J. Gastroenterol. 1978; 13: 3–15.PubMedCrossRefGoogle Scholar
  15. 15.
    Ribet A, Tournut R, Duffaut M, Vaysse M. Use of caerulein with submaximal doses of secretin as a test of pancreatic function in man.Gut. 1976; 17: 431–434.PubMedCrossRefGoogle Scholar
  16. 16.
    Gullo L, Costa PL, Fontana G, Labo’ G. Investigation of exocrine pancreatic function by continuous infusion of caerulein and secretin in normal subjects and in chronic pancreatitis. Digestion 1976; 14: 97–107.PubMedGoogle Scholar
  17. 17.
    Sarles H, Taulier J, Figarella C. Dosage de la lipase dans le suc duodenal. Rev. Franc. Etud. Clin. Biol. 1963; 8: 706, 707.PubMedGoogle Scholar
  18. 18.
    Figarella C, Taulier J, Sarles H. Dosage de la chymotrypsine et de la trypsine dans le suc duodenal. Bull. Soc. Chim. Biol. 1965; 47: 679–686.PubMedGoogle Scholar
  19. 19.
    Di Magno EP, Go VLW, Summerskill WHJ. Relation between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N. Eng. J. Med. 1973; 288: 813–815.Google Scholar
  20. 20.
    Knoke D, Burke PJ. Log-linear models. Sage University Paper series on quantitative applications in the social sciences. Sage Publications, Beverly Hills, 1980.Google Scholar
  21. 21.
    Baker RJ, Neider JA. The GLIM system, release 3: generalised linear interactive modelling. Royal Statistical Society Publication, London, 1979.Google Scholar
  22. 22.
    Ammann RW, Tagwercher E, Kashiwagi H, Rosenmund H. Diagnostic value of fecal chymotrypsin and trypsin assessment for detection of pancreatic disease. A comparative study. Am. J. Dig. Dis. 1968; 13: 123–146.PubMedCrossRefGoogle Scholar
  23. 23.
    Nagata A, Homma T, Oguchi H, Tamura Y, Hirabayashi H, Sasaki Y, Kawa S, Monno S, Shimakura K, Shirai T, Furuta S. Study of chronic alcoholic pancreatitis by means of serial pancreozymin-secretin tests. Digestion 1986; 33: 135–145.PubMedCrossRefGoogle Scholar
  24. 24.
    Braganza JM, Hunt LP, Warwick F. Relationship between pancreatic exocrine function and ductal morphology in chronic pancreatitis. Gastroenterology 1982; 82: 1341–1347.PubMedGoogle Scholar
  25. 25.
    Wormsley KG. The source of duodenal aspirate in man. Gut. 1968; 9: 398–404.PubMedCrossRefGoogle Scholar
  26. 26.
    Austin JL, Roberts C, Rosenholtz MJ, Reber HA. Effects of partial duct obstruction and drainage on pancreatic function. J. Surg. Res. 1980; 28: 426–433.PubMedCrossRefGoogle Scholar
  27. 27.
    Nakamura K, Sarles H, Payan H. Three-dimensional reconstruction of the pancreatic ducts in chronic pancreatitis. Gastroenterology 1972; 62: 942–949.PubMedGoogle Scholar
  28. 28.
    Bordalo O, Baptista A, Dreiling D, Noronha M. Early pathomorphological pancreatic changes in chronic alcoholism. Pancreatitis-Concepts and classification, Gyr KE, Singer MV, Sarles H, eds. Excerpta Medica, Elsevier, Amsterdam, 1984; 57–60.Google Scholar
  29. 29.
    Petersen H, Myren J. Secretin dose-response in healthy and in chronic pancreatic inflammatory disease. Scand. J. Gastroenterol. 1975; 10: 851–861.PubMedGoogle Scholar
  30. 30.
    Dürr GH. The Secretin-Pancreozymin (Caerulein)-test. Methodological problems. Pancreatitis: Concepts and classification, Gyr KE, Singer MV, Sarles H. eds., Excerpta Medica, Elsevier, Amsterdam, 1984; 261–266.Google Scholar

Copyright information

© Humana Press Inc. 1990

Authors and Affiliations

  • Ludovico A. Scuro
    • 1
  • Giorgio Cavallini
    • 1
  • Luigi Benini
    • 1
  • Giorgio Brocco
    • 1
  • Paolo Bovo
    • 1
  • Andreina Riela
    • 1
  • Michele Togni
    • 1
  • Giovanni Cataudella
    • 1
  • Claudio Bassi
    • 2
  • Paolo Pederzoli
    • 2
  • Rocco Micciolo
    • 3
  1. 1.Clinica Medica UniversityVeronaItaly
  2. 2.Clinica Chirurgica UniversityVeronaItaly
  3. 3.Istituto di Statistica e Ricerca Operativa UniversityTrentoItaly

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