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Chronische Pankreatitis

Klinik, Verlauf und Diagnostik

Chronic pancreatitis

Clinic, course and diagnostics

  • Schwerpunkt: Pankreaserkrankungen
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

In 80% der Fälle geht der klinischen Erstmanifestation einer chronischen Pankreatitis ein jahrelanger Alkoholmissbrauch voraus. Die sog. idiopathische Pankreatitis kann mit SPINK- oder CFTR-Mutationen assoziiert sein.

Ein jahrzehntelanger Entzündungsprozess des Pankreas ist ein Risikofaktor für die Entwicklung eines Pankreaskarzinoms: In der Diagnostik sinkt die Bedeutung von Funktionsuntersuchungen. Bildgebende Verfahren sind wichtig für die primäre Diagnosefindung und zur Planung des therapeutischen Procedere. Die MRCP ist ein wenig invasives Verfahren zum Nachweis von Gallenwegs- und Pankreasgangstenosen und -erweiterungen. Die ERCP wird in der Regel nur noch im Rahmen interventionell therapeutischer Verfahren eingesetzt, z. B. Überbrückung von Stenosen mittels Stents, Entfernung von Pankreasgangkonkrementen nach extrakorporaler Stoßwellenlithotripsie, Drainage von Pseudozysten. Die Endosonographie ist das derzeit sensitivste bildgebende Verfahren für eine frühe Diagnose, mittels zugeschaltetem Doppler-Signal lassen sich Gefäße nachweisen, deren Punktion bei der Drainage vermieden werden muss. In der CT lässt sich ein entzündlicher Pankreaskopftumor nachweisen, Verkalkungen, Pseudozysten. Ob mittels Positronenemissionstomographie das Problem der rechtzeitigen Diagnose eines Karzinoms auf dem Boden der Entzündung gelöst werden kann, ist mehr als fraglich. Studien müssen klären, ob mittels endosonographisch gesteuerter Pankreaspunktion das differenzialdiagnostische Problem des unklaren Pankreastumors besser gelöst werden kann.

Summary

The fist clinical manifestation of chronic pancreatitis is due to long-term alcohol abuse in 80% of cases. So called idiopathic pancreatitis can be associated with SPINK or CFTR mutations.

An inflammatory process lasting a decade or more is a risk factor for the development of pancreas cancer. Functional examination is becoming less important in diagnostics. Imaging techniques are important for primary diagnosis and for the planning of treatment. MRCP is a minimally invasive technique for demonstrating bile duct and pancreatic duct stenosis and extension. ERCP is usually only used within the framework of interventional therapy, e.g. bridging of stenoses using stents, removal of pancreatic duct concrements after extracorporeal shock wave lithotripsy, and drainage of pseudocysts. Endosonography is currently the most sensitive imaging technique for an early diagnosis, and Doppler signals show vessels which must not be damaged during drainage. CT shows inflamed pancreas tumors, calcifications and pseudocysts. Whether positron emission tomography will solve the problem of timely diagnosis of cancer as consequence of chronic inflammation is more than questionable. Studies are needed to clarify whether endoscopically steered pancreas biopsy can solve the problem of unclear pancreas tumors.

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Literatur

  1. Adamek HE, Albert J, Breer H, Weitz M, Schilling D, Riemann JF (2000) Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study. Lancet 356: 1607–1608

    Google Scholar 

  2. Ammann RW, Muellhaupt B (1999) The natural history of pain in alcoholic chronic pancreatitis. Gastroenterology 116: 1132–1140

    Google Scholar 

  3. Ammann RW, Muench R, Otto R, Buehler H, Freiburghaus AU, Siegenthaler W (1988) Evolution and regression of pancreatic calcification in chronic pancreatitis. A prospective long-term study of 107 patients. Gastroenterology 95: 1018–1028

    Google Scholar 

  4. Ammann RW, Muellhaupt B, Meyenberger C, Heitz PU (1994) Alcoholic nonprogressive chronic pancreatitis: prospective long-term study of a large cohort with alcoholic acute pancreatitis (1976–1992). Pancreas 9: 365–373

    Google Scholar 

  5. Ammann RW, Heitz PU, Klöppel G (1996) Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology 111: 224–231

    Google Scholar 

  6. Aparisi L, Farre A, Gomez-Cambronero L et al. (2005) Antibodies to carbonic anhydrase and IgG4 levels in idiopathic chronic pancreatitis: relevance for diagnosis of autoimmune pancreatitis. Gut 54: 703–709

    Google Scholar 

  7. Audrezet MP, Chen JM, Le Marechal C et al. (2002) Determination of the relative contribution of three genes — the cystic fibrosis transmembrane conductance regulator gene, the cationic trypsinogen gene, and the pancreatic secretory trypsin inhibitor gene-to the etiology of idiopathic chronic pancreatitis. Eur J Hum Genet 10: 100–106

    Google Scholar 

  8. Bali MA, Sztantics A, Metens T, Arvanitakis M, Delhaye M, Deviere J, Matos C (2005) Quantification of pancreatic exocrine function with secretin-enhanced magnetic resonance cholangiopancreatography: normal values and short-term effects of pancreatic duct drainage procedures in chronic pancreatitis. Initial results. Eur Radiol 15: 2110–2121

    Google Scholar 

  9. Böhmig M, Rosewicz S (2004) Pankreaskarzinom. Z Gastroenterol 42: 261–268

    Google Scholar 

  10. Bourliere M, Barthet M, Berthezene P, Durbec JP, Sarles H (1991) Is tobacco a risk factor for chronic pancreatitis and alcoholic cirrhosis? Gut 32: 1392–1395

    Google Scholar 

  11. Bozkurt T, Braun U, Leferink S, Gilly G, Lux G (1994) Comparison of pancreatic morphology and exocrine functional impairment in patients with chronic pancreatitis. Gut 35: 1132–1136

    Google Scholar 

  12. Buscail L, Escourrou J, Moreau J et al. (1995) Endoscopic ultrasonography in chronic pancreatitis: a comparative prospective study with conventional ultrasonography, computed tomography, and ERCP. Pancreas 10: 251–257

    Google Scholar 

  13. Calvo MM, Bujanda L, Calderon A et al. (2002) Comparison between magnetic resonance cholangiopancreatography and ERCP for evaluation of the pancreatic duct. Am J Gastroenterol 97: 347–353

    Google Scholar 

  14. Catalano MF, Lahoti S, Geenen JE, Hogan WJ (1998) Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis. Gastrointest Endosc 48: 11–17

    Google Scholar 

  15. Chen JM, Mercier B, Audrezet MP, Ferec (2000) Mutational analysis of the human pancreatic secretory trypsin inhibitor (PSTI) gene in hereditary and sporadic chronic pancreatitis. J Med Genet 37: 67–69

  16. Cohn JA, Friedman KJ, Noone PG, Knowles MR, Silverman LM, Jowell PS (1998) Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis. N Engl J Med 339: 653–658

    Google Scholar 

  17. Czako L, Takacs T, Morvay Z, Csernay L, Lonovics J (2004) Diagnostic role of secretin-enhanced MRCP in patients with unsuccessful ERCP. World J Gastroenterol 10: 3034–3038

    Google Scholar 

  18. DiMagno EP, Go VL, Summerskill WH (1973) Relations between pancreatic enzyme ouputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 288: 813–815

    Google Scholar 

  19. DiMagno MJ, DiMagno EP (2005) Chronic pancreatitis. Curr Opin Gastroenterol 21: 544–554

    Google Scholar 

  20. Di Stasi M, Lencioni R, Solmi L et al. (1998) Ultrasound-guided fine needle biopsy of pancreatic masses: results of a multicenter study. Am J Gastroenterol 93: 1329–1333

    Google Scholar 

  21. Durbec JP, Sarles H (1978) Multicenter survey of the etiology of pancreatic diseases. Relationship between the relative risk of developing chronic pancreatitis and alcohol, protein and lipid consumption. Digestion 18: 337–350

    Google Scholar 

  22. Farrell JJ, Garber J, Sahani D, Brugge WR (2004) EUS findings in patients with autoimmune pancreatitis. Gastrointest Endosc 60: 927–936

    Google Scholar 

  23. Glaser J, Högemann B, Krummenerl T, Schneider M, Hultsch E, Husen N van, Gerlach U (1987) Sonographic imaging of the pancreatic duct. New diagnostic possibilities using secretin stimulation. Dig Dis Sci 32: 1075–1081

    Google Scholar 

  24. Gorry MC, Gabbaizedeh D, Furey W et al. (1997) Mutations in the cationic trypsinogen gene are associated with recurrent acute and chronic pancreatitis. Gastroenterology 113: 1063–1068

    Google Scholar 

  25. Hassan Z, Mohan V, Ali L et al. (2002) SPINK1 is a susceptibility gene for fibrocalculous pancreatic diabetes in subjects from the Indian subcontinent. Am J Hum Genet 71: 964–968

    Google Scholar 

  26. Hastier P, Buckley MJ, Francois E, Peten EP, Dumas R, Caroli-Bosc FX, Delmont JP (1999) A prospective study of pancreatic disease in patients with alcoholic cirrhosis: comparative diagnostic value of ERCP and EUS and long-term significance of isolated parenchymal abnormalities. Gastrointest Endosc 49: 705–709

    Google Scholar 

  27. Hellerhoff KJ, Helmberger H 3rd, Rosch T, Settles MR, Link TM, Rummeny EJ (2002) Dynamic MR pancreatography after secretin administration: image quality and diagnostic accuracy. AJR Am J Roentgenol 179: 121–129

    Google Scholar 

  28. Howes N, Lerch MM, Greenhalf W et al., European Registry of Hereditary Pancreatitis and Pancreatic Cancer (EUROPAC) (2004) Clinical and genetic characteristics of hereditary pancreatitis in Europe. Clin Gastroenterol Hepatol 2: 252–261

    Google Scholar 

  29. Kahl S, Glasbrenner B, Leodolter A, Pross M, Schulz HU, Malfertheiner P (2002) EUS in the diagnosis of early chronic pancreatitis: a prospective follow-up study. Gastrointest Endosc 55: 507–511

    Google Scholar 

  30. Keim V, Bauer N, Teich N, Simon P, Lerch MM, Mössner J (2001) Clinical characterization of patients with hereditary pancreatitis and mutations in the cationic trypsinogen gene. Am J Med 111: 622–626

    Google Scholar 

  31. Keim V, Witt H, Bauer N, Bödeker H, Rosendahl J, Teich N, Mössner J (2003) The course of genetically determined chronic pancreatitis. JOP 4: 146–154

    Google Scholar 

  32. Kouwen MC van, Jansen JB, Goor H van, Castro S de, Oyen WJ, Drenth JP (2005) FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis. Eur J Nucl Med Mol Imaging 32: 399–404

    Google Scholar 

  33. Lankisch PG, Lowenfels AB, Maisonneuve P (2002) What is the risk of alcoholic pancreatitis in heavy drinkers? Pancreas 25: 411–412

    Google Scholar 

  34. Layer P, Yamamoto H, Kalthoff L, Clain JE, Bakken LJ, DiMagno EP (1994) The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology 107: 1481–1487

    Google Scholar 

  35. Levy MJ, Reddy RP, Wiersema MJ, Smyrk TC, Clain JE, Harewood GC, Pearson RK (2005) EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice. Gastrointest Endosc 61: 467–472

    Google Scholar 

  36. Lowenfels AB, Maisonneuve P, Cavallini G et al. (1993) Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 328: 1433-1437

    Google Scholar 

  37. Lowenfels AB, Maisonneuve P, Cavallini G et al. (1994) Prognosis of chronic pancreatitis: an international multicenter study. International Pancreatitis Study Group. Am J Gastroenterol 89: 1467–1471

    Google Scholar 

  38. Lowenfels AB, Maisonneuve P, DiMagno EP, Elitsur Y, Gates LK jr, Perrault J, Whitcomb DC (1997) Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group. J Natl Cancer Inst 89: 442–446

    Google Scholar 

  39. Lowenfels AB, Maisonneuve P, Whitcomb DC (2000) Risk factors for cancer in hereditary pancreatitis. International Hereditary Pancreatitis Study Group. Med Clin North Am 84: 565–573

  40. Luetmer PH, Stephens DH, Ward EM (1989) Chronic pancreatitis: reassessment with current CT. Radiology 171: 353–357

    Google Scholar 

  41. Maisonneuve P, Lowenfels AB, Mullhaupt B et al. (2005) Cigarette smoking accelerates progression of alcoholic chronic pancreatitis. Gut 54: 510–514

    Google Scholar 

  42. Malka D, Hammel P, Maire F et al. (2002) Risk of pancreatic adenocarcinoma in chronic pancreatitis. Gut 51: 849–852

    Google Scholar 

  43. Manfredi R, Costamagna G, Brizi MG, Maresca G, Vecchioli A, Colagrande C, Marano P (2002) Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulation. Radiology 214: 849–855

    Google Scholar 

  44. Monaghan KG, Jackson CE, KuKuruga DL, Feldman GL (2000) Mutation analysis of the cystic fibrosis and cationic trypsinogen genes in patients with alcohol-related pancreatitis. Am J Med Genet 94: 120–124

    Google Scholar 

  45. Osawa S, Kataoka K, Sakagami J et al. (2002) Relation between morphologic changes in the main pancreatic duct and exocrine pancreatic function after a secretin test. Pancreas 25: 12–19

    Google Scholar 

  46. Pfützer RH, Whitcomb DC (1999) Trypsinogen mutations in chronic pancreatitis. Gastroenterology 117: 1507–1508

    Google Scholar 

  47. Sahai AV, Mishra G, Penman ID et al. (2000) EUS to detect evidence of pancreatic disease in patients with persistent or nonspecific dyspepsia. Gastrointest Endosc 52: 153–159

    Google Scholar 

  48. Sarner M, Cotton PB (1984) Classification of pancreatitis. Gut 25: 756–759

    Google Scholar 

  49. Sharer N, Schwarz M, Malone G, Howarth A, Painter J, Super M, Braganza J (1998) Mutations of the cystic fibrosis gene in patients with chronic pancreatitis. N Engl J Med 339: 645–652

    Google Scholar 

  50. Sica GT, Braver J, Cooney MJ, Miller FH, Chai JL, Adams DF (1999) Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis. Radiology 210: 605–610

    Google Scholar 

  51. Siegmund E, Löhr JM, Schuff-Werner P (2004) The diagnostic validity of non-invasive pancreatic function tests — a meta-analysis. Z Gastroenterol 42: 1117–1128

    Google Scholar 

  52. Sossenheimer MJ, Aston CE, Preston RA et al. (1997) Clinical characteristics of hereditary pancreatitis in a large family, based on high-risk haplotype. The Midwest Multicenter Pancreatic Study Group (MMPSG). Am J Gastroenterol 92: 1113–1116

    Google Scholar 

  53. Teich N, Mossner J, Keim V (1998) Mutations of the cationic trypsinogen in hereditary pancreatitis. Hum Mutat 12: 39–43

    Google Scholar 

  54. Teich N, Mössner J, Keim V (1999) Screening for mutations of the cationic trypsinogen gene: are they of relevance in chronic alcoholic pancreatitis? Gut 44: 413–416

    Google Scholar 

  55. Teich N, Ockenga J, Hoffmeister A, Manns M, Mössner J, Keim V (2000) Chronic pancreatitis associated with an activation peptide mutation that facilitates trypsin activation. Gastroenterology 19: 461–465

    Google Scholar 

  56. Teich N, Bauer N, Mössner J, Keim V (2002) Mutational screening of patients with nonalcoholic chronic pancreatitis: identification of further trypsinogen variants. Am J Gastroenterol 97: 341–346

    Google Scholar 

  57. Wallace MB, Hawes RH, Durkalski V et al. (2001) The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers. Gastrointest Endosc 53: 294–299

    Google Scholar 

  58. Whitcomb DC, Gorry MC, Preston RA et al. (1996) Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet 14: 141–145

    Google Scholar 

  59. Whitcomb DC, Preston RA, Aston CE et al. (1996) A gene for hereditary pancreatitis maps to chromosome 7q35.Gastroenterology 110: 1975–1980

    Google Scholar 

  60. Wiersema MJ, Hawes RH, Lehman GA, Kochman ML, Sherman S, Kopecky KK (1993) Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin. Endoscopy 25: 555–564

    Google Scholar 

  61. Witt H, Luck W, Hennies HC et al. (2000) Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis. Nat Genet 25: 213–216

    Google Scholar 

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  1. Medizinische Klinik und Poliklinik II, Universität Leipzig, Philipp-Rosenthal-Straße 27, 04103, Leipzig

    J. Mössner

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Mössner, J. Chronische Pankreatitis. Gastroenterologe 1, 18–26 (2006). https://doi.org/10.1007/s11377-006-0005-1

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