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Chronic Gastrointestinal Dysmotility and Pain Following Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The prevalence and impact of chronic gastrointestinal dysmotility following total pancreactectomy with islet autotransplantation (TP-IAT) for chronic pancreatitis is not known.

Methods

A cross-sectional study of all patients who underwent TP-IAT at our institution from August 2011 to November 2015 was undertaken. The GCSI (Gastroparesis Cardinal Symptom Index), PAGI-SYM (Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index), PAC-SYM (Patient Assessment of Constipation Symptoms), Bristol stool chart, 12-item Short Form Health Survey (SF-12), and visual analog scale for pain were administered ≥4 weeks following TP-IAT.

Key Results

The prevalence of any dysmotility symptoms in patients who completed the survey (33/45, 73%) post-TP-IAT was 45%. Post-TP-IAT, the mean reduction in opioid dosing was 77.6 oral morphine equivalents (OMEs) (95% CI 32.1–123.0, p = 0.002) with 42% of patients requiring no opioids. There was significant negative correlation between dysmotility scores and SF-12 physical scores (r = −0.46, p = 0.008, 95% CI −0.70 to −0.13). Self-reported abdominal pain had significant negative correlation with both physical and mental SF-12 scores (r = −0.67, p < 0.001, 95% CI −0.83 to −0.41 and r = −0.39, p = 0.03, 95% CI −0.65 to −0.04). There was no correlation between gastrointestinal dysmotility and self-reported pain.

Conclusions and Inferences

Symptoms of chronic gastrointestinal dysmotility and chronic abdominal pain are common post-TP-IAT and will need to be better recognized and differentiated to improve the management of these patients.

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Acknowledgements

GKJ, EMS, and VKS were involved in the concept and design of this study. MM and KH performed all surgeries, and CW provided pre- and post-operative care and data collection for pain surveys. DW, ND, and ZS performed the islet transplants. EMS collected all symptom surveys and provided care and management of TP-IAT patients with motility disorders. GKJ reviewed patient surveys, extracted data, performed statistical analysis, and wrote the first draft of the manuscript. All authors critically appraised and revised the manuscript. All authors gave the final approval for submission of the manuscript.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA

    George K. John, Vikesh K. Singh, Robert A. Moran, Christi Walsh & Ellen M. Stein

  2. Pancreatitis Center, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA

    Vikesh K. Singh, Robert A. Moran, Kenzo Hirose, Martin A. Makary & Ellen M. Stein

  3. Division of Surgical Oncology, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA

    Daniel Warren, Zhaoli Sun, Niraj Desai, Kenzo Hirose & Martin A. Makary

  4. Division of Transplant Surgery, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA

    Rita R. Kalyani & Erica Hall

  5. Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins Hospital, 1830 East Monument St, Suite 429, Baltimore, MD, 21287, USA

    Ellen M. Stein

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  1. George K. John
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Correspondence to Ellen M. Stein.

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Ethical approval for this study was obtained from the Johns Hopkins Medicine Institutional Review Board.

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John, G.K., Singh, V.K., Moran, R.A. et al. Chronic Gastrointestinal Dysmotility and Pain Following Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis. J Gastrointest Surg 21, 622–627 (2017). https://doi.org/10.1007/s11605-016-3348-z

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  • DOI: https://doi.org/10.1007/s11605-016-3348-z

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