Use and perceived effectiveness of non-analgesic medical therapies for chronic pancreatitis in the United States

F. Burton, S. Alkaade, D. Collins, V. Muddana, A. Slivka, R. E. Brand, A. Gelrud, P. A. Banks, S. Sherman, M. A. Anderson, J. Romagnuolo, C. Lawrence, J. Baillie, T. B. Gardner, M. D. Lewis, S. T. Amann, J. G. Lieb, M. O'Connell, E. D. Kennard, D. YadavD. C. Whitcomb, C. E. Forsmark

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Effectiveness of medical therapies in chronic pancreatitis has been described in small studies of selected patients. Aim: To describe frequency and perceived effectiveness of non-analgesic medical therapies in chronic pancreatitis patients evaluated at US referral centres. Methods: Using data on 516 chronic pancreatitis patients enrolled prospectively in the NAPS2 Study, we evaluated how often medical therapies [pancreatic enzyme replacement therapy (PERT), vitamins/antioxidants (AO), octreotide, coeliac plexus block (CPB)] were utilized and considered useful by physicians. Results: Oral PERT was commonly used (70%), more frequently in the presence of exocrine insufficiency (EI) (88% vs. 61%, P < 0.001) and pain (74% vs. 59%, P < 0.002). On multivariable analyses, predictors of PERT usage were EI (OR 5.14, 95% CI 2.87-9.18), constant (OR 3.42, 95% CI 1.93-6.04) or intermittent pain (OR 1.98, 95% CI 1.14-3.45). Efficacy of PERT was predicted only by EI (OR 2.16, 95% CI 1.36-3.42). AO were tried less often (14%) and were more effective in idiopathic and obstructive vs. alcoholic chronic pancreatitis (25% vs. 4%, P = 0.03). Other therapies were infrequently used (CPB - 5%, octreotide - 7%) with efficacy generally <50%. Conclusions Pancreatic enzyme replacement therapy is commonly utilized, but is considered useful in only subsets of chronic pancreatitis patients. Other medical therapies are used infrequently and have limited efficacy.

Original languageEnglish (US)
Pages (from-to)149-159
Number of pages11
JournalAlimentary Pharmacology and Therapeutics
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2011

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Enzyme Replacement Therapy
Chronic Pancreatitis
Celiac Plexus
Octreotide
Antioxidants
Alcoholic Pancreatitis
Therapeutics
Pain
Vitamins
Referral and Consultation
Physicians

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

Cite this

Use and perceived effectiveness of non-analgesic medical therapies for chronic pancreatitis in the United States. / Burton, F.; Alkaade, S.; Collins, D.; Muddana, V.; Slivka, A.; Brand, R. E.; Gelrud, A.; Banks, P. A.; Sherman, S.; Anderson, M. A.; Romagnuolo, J.; Lawrence, C.; Baillie, J.; Gardner, T. B.; Lewis, M. D.; Amann, S. T.; Lieb, J. G.; O'Connell, M.; Kennard, E. D.; Yadav, D.; Whitcomb, D. C.; Forsmark, C. E.

In: Alimentary Pharmacology and Therapeutics, Vol. 33, No. 1, 01.01.2011, p. 149-159.

Research output: Contribution to journalArticle

Burton, F, Alkaade, S, Collins, D, Muddana, V, Slivka, A, Brand, RE, Gelrud, A, Banks, PA, Sherman, S, Anderson, MA, Romagnuolo, J, Lawrence, C, Baillie, J, Gardner, TB, Lewis, MD, Amann, ST, Lieb, JG, O'Connell, M, Kennard, ED, Yadav, D, Whitcomb, DC & Forsmark, CE 2011, 'Use and perceived effectiveness of non-analgesic medical therapies for chronic pancreatitis in the United States', Alimentary Pharmacology and Therapeutics, vol. 33, no. 1, pp. 149-159. https://doi.org/10.1111/j.1365-2036.2010.04491.x
Burton, F. ; Alkaade, S. ; Collins, D. ; Muddana, V. ; Slivka, A. ; Brand, R. E. ; Gelrud, A. ; Banks, P. A. ; Sherman, S. ; Anderson, M. A. ; Romagnuolo, J. ; Lawrence, C. ; Baillie, J. ; Gardner, T. B. ; Lewis, M. D. ; Amann, S. T. ; Lieb, J. G. ; O'Connell, M. ; Kennard, E. D. ; Yadav, D. ; Whitcomb, D. C. ; Forsmark, C. E. / Use and perceived effectiveness of non-analgesic medical therapies for chronic pancreatitis in the United States. In: Alimentary Pharmacology and Therapeutics. 2011 ; Vol. 33, No. 1. pp. 149-159.
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abstract = "Background: Effectiveness of medical therapies in chronic pancreatitis has been described in small studies of selected patients. Aim: To describe frequency and perceived effectiveness of non-analgesic medical therapies in chronic pancreatitis patients evaluated at US referral centres. Methods: Using data on 516 chronic pancreatitis patients enrolled prospectively in the NAPS2 Study, we evaluated how often medical therapies [pancreatic enzyme replacement therapy (PERT), vitamins/antioxidants (AO), octreotide, coeliac plexus block (CPB)] were utilized and considered useful by physicians. Results: Oral PERT was commonly used (70{\%}), more frequently in the presence of exocrine insufficiency (EI) (88{\%} vs. 61{\%}, P < 0.001) and pain (74{\%} vs. 59{\%}, P < 0.002). On multivariable analyses, predictors of PERT usage were EI (OR 5.14, 95{\%} CI 2.87-9.18), constant (OR 3.42, 95{\%} CI 1.93-6.04) or intermittent pain (OR 1.98, 95{\%} CI 1.14-3.45). Efficacy of PERT was predicted only by EI (OR 2.16, 95{\%} CI 1.36-3.42). AO were tried less often (14{\%}) and were more effective in idiopathic and obstructive vs. alcoholic chronic pancreatitis (25{\%} vs. 4{\%}, P = 0.03). Other therapies were infrequently used (CPB - 5{\%}, octreotide - 7{\%}) with efficacy generally <50{\%}. Conclusions Pancreatic enzyme replacement therapy is commonly utilized, but is considered useful in only subsets of chronic pancreatitis patients. Other medical therapies are used infrequently and have limited efficacy.",
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AU - Burton, F.

AU - Alkaade, S.

AU - Collins, D.

AU - Muddana, V.

AU - Slivka, A.

AU - Brand, R. E.

AU - Gelrud, A.

AU - Banks, P. A.

AU - Sherman, S.

AU - Anderson, M. A.

AU - Romagnuolo, J.

AU - Lawrence, C.

AU - Baillie, J.

AU - Gardner, T. B.

AU - Lewis, M. D.

AU - Amann, S. T.

AU - Lieb, J. G.

AU - O'Connell, M.

AU - Kennard, E. D.

AU - Yadav, D.

AU - Whitcomb, D. C.

AU - Forsmark, C. E.

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N2 - Background: Effectiveness of medical therapies in chronic pancreatitis has been described in small studies of selected patients. Aim: To describe frequency and perceived effectiveness of non-analgesic medical therapies in chronic pancreatitis patients evaluated at US referral centres. Methods: Using data on 516 chronic pancreatitis patients enrolled prospectively in the NAPS2 Study, we evaluated how often medical therapies [pancreatic enzyme replacement therapy (PERT), vitamins/antioxidants (AO), octreotide, coeliac plexus block (CPB)] were utilized and considered useful by physicians. Results: Oral PERT was commonly used (70%), more frequently in the presence of exocrine insufficiency (EI) (88% vs. 61%, P < 0.001) and pain (74% vs. 59%, P < 0.002). On multivariable analyses, predictors of PERT usage were EI (OR 5.14, 95% CI 2.87-9.18), constant (OR 3.42, 95% CI 1.93-6.04) or intermittent pain (OR 1.98, 95% CI 1.14-3.45). Efficacy of PERT was predicted only by EI (OR 2.16, 95% CI 1.36-3.42). AO were tried less often (14%) and were more effective in idiopathic and obstructive vs. alcoholic chronic pancreatitis (25% vs. 4%, P = 0.03). Other therapies were infrequently used (CPB - 5%, octreotide - 7%) with efficacy generally <50%. Conclusions Pancreatic enzyme replacement therapy is commonly utilized, but is considered useful in only subsets of chronic pancreatitis patients. Other medical therapies are used infrequently and have limited efficacy.

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