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Chronische Pankreatitis: Klinik, Labordiagnostik und bildgebende Diagnostik

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DGIM Innere Medizin

Part of the book series: Springer Reference Medizin ((SRM))

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Zusammenfassung

Die chronische Pankreatitis ist eine entzündliche Erkrankung, die zu strukturellen Veränderungen des Organs in Form einer Fibrose und zu einer Einschränkung der endokrinen und exokrinen Funktion führt. Die Leitsymptome der Erkrankung sind abdominelle Schmerzen meist besonders starker Ausprägung, Maldigestion infolge der exokrinen Pankreasinsuffizienz und Diabetes mellitus. Spezifische Laborparameter zum Nachweis oder Ausschluss einer chronischen Pankreatitis existieren nicht. Wenn es um die Abklärung der Ätiologie einer chronischen Pankreatitis geht, sind spezifische Laboruntersuchungen im Rahmen eines Stufenkonzeptes jedoch sinnvoll. Die Diagnose der chronischen Pankreatitis basiert auf morphologischen Veränderungen des Organs in Verbindung mit klinischen und funktionellen Parametern und ist in fortgeschrittenen Erkrankungsstadien einfach. Sie stellt jedoch eine diagnostische Herausforderung dar, solange die strukturellen Organveränderungen nicht fortgeschritten sind. Präferenziell sollten nicht invasive Untersuchungsmethoden angewendet werden.

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Literatur

  • Adler G, Mundlos S, Kühnelt P, Dreyer E (1993) New methods for assessment of enzyme activity: do they help to optimize enzyme treatment? Digestion 54(Suppl 2):3–9

    Article  CAS  PubMed  Google Scholar 

  • Ahmed Ali U, Nieuwenhuijs VB, van Eijck CH, Gooszen HG, van Dam RM, Busch OR et al (2012) Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief. Arch Surg 147(10):925–932

    PubMed  Google Scholar 

  • Alexakis N, Connor S, Ghaneh P, Raraty M, Lombard M, Smart H et al (2004) Influence of opioid use on surgical and long-term outcome after resection for chronic pancreatitis. Surgery 136(3):600–608

    Article  CAS  PubMed  Google Scholar 

  • Ali A, Usama P, Johanna M, Nealon WH, van Goor H, Gooszen HG, Boermeester MA (2012) Endoscopic or surgical intervention for painful obstructive chronic pancreatitis. Cochrane Database Syst Rev 1, CD007884

    Google Scholar 

  • Ammann RW (1996) Pain profile in alcoholic and nonalcoholic chronic pancreatitis (CP). Pancreas 12(3):315–318

    Article  CAS  PubMed  Google Scholar 

  • Ammann RW, Muellhaupt B (1999) The natural history of pain in alcoholic chronic pancreatitis. Gastroenterology 116(5):1132–1140

    Article  CAS  PubMed  Google Scholar 

  • Ammann RW, Akovbiantz A, Largiader F, Schueler G (1984) Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology 86(5 Pt 1):820–828

    CAS  PubMed  Google Scholar 

  • Ammann RW, Buehler H, Muench R, Freiburghaus AW, Siegenthaler W (1987) Differences in the natural history of idiopathic (nonalcoholic) and alcoholic chronic pancreatitis. A comparative long-term study of 287 patients. Pancreas 2(4):368–377

    Article  CAS  PubMed  Google Scholar 

  • 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(4):1018–1028

    CAS  PubMed  Google Scholar 

  • Ammann RW, Heitz PU, Klöppel G (1996) Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology 111(1):224–231

    Article  CAS  PubMed  Google Scholar 

  • Bagul A, Siriwardena AK (2006) Evaluation of the Manchester classification system for chronic pancreatitis. JOP 7(4):390–396

    PubMed  Google Scholar 

  • Beger HG (1987) Die duodenumerhaltende Pankreaskopfresektion bei chronischer Pankreatitis. Langenbecks Arch Chir 372:357–362

    Article  CAS  PubMed  Google Scholar 

  • Beger HG, Schlosser W, Friess HM, Büchler MW (1999) Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience. Ann Surg 230(4):512–519; discussion 519–523

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Braganza JM, Lee SH, McCloy RF, McMahon MJ (2011) Chronic pancreatitis. Lancet 377(9772):1184–1197

    Article  CAS  PubMed  Google Scholar 

  • Büchler MW, Martignoni ME, Friess H, Malfertheiner P (2009) A proposal for a new clinical classification of chronic pancreatitis. BMC Gastroenterol 9:93

    Article  PubMed Central  PubMed  Google Scholar 

  • Cahen DL, van Berkel A-MM, Oskam D, Rauws EAJ, Weverling GJ, Huibregtse K, Bruno MJ (2005) Long-term results of endoscopic drainage of common bile duct strictures in chronic pancreatitis. Eur J Gastroenterol Hepatol 17(1):103–108

    Article  PubMed  Google Scholar 

  • Cahen DL, Gouma DJ, Laramée P, Nio Y, Rauws EAJ, Boermeester MA et al (2011) Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology 141(5):1690–1695

    Article  PubMed  Google Scholar 

  • Catalano MF, Sahai A, Levy M, Romagnuolo J, Wiersema M, Brugge W et al (2009) EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc 69(7):1251–1261

    Article  PubMed  Google Scholar 

  • Diagnosis and classification of diabetes mellitus (2012). Diabetes Care 35 (Suppl 1) :S 64–71

    Google Scholar 

  • DiMagno EP, Go VL, Summerskill WH (1973) Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 288(16):813–815

    Article  CAS  PubMed  Google Scholar 

  • Díte P, Ruzicka M, Zboril V, Novotný I (2003) A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 35(7):553–558

    Article  PubMed  Google Scholar 

  • Fitzsimmons D, Kahl S, Butturini G, van Wyk M, Bornman P, Bassi C et al (2005) Symptoms and quality of life in chronic pancreatitis assessed by structured interview and the EORTC QLQ-C30 and QLQ-PAN26. Am J Gastroenterol 100(4):918–926

    Article  PubMed  Google Scholar 

  • Ghoos YF, Vantrappen GR, Rutgeerts PJ, Schurmans PC (1981) A mixed-triglyceride breath test for intraluminal fat digestive activity. Digestion 22(5):239–247

    Article  CAS  PubMed  Google Scholar 

  • Gullo L, Barbara L, Labò G (1988) Effect of cessation of alcohol use on the course of pancreatic dysfunction in alcoholic pancreatitis. Gastroenterology 95(4):1063–1068

    CAS  PubMed  Google Scholar 

  • Hoffmeister A, Mayerle J, Beglinger C, Büchler MW, Bufler P, Dathe K et al (2012) S3-Leitlinie Chronische Pankreatitis: Definition, Ätiologie, Diagnostik, konservative, interventionell endoskopische und operative Therapie der chronischen Pankreatitis. Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol 50(11):1176–1224

    Article  CAS  PubMed  Google Scholar 

  • Keck T, Adam U, Makowiec F, Riediger H, Wellner U, Tittelbach-Helmrich D, Hopt UT (2012) Short- and long-term results of duodenum preservation versus resection for the management of chronic pancreatitis: a prospective, randomized study. Surgery 152(3 Suppl 1):S95–S102

    Article  PubMed  Google Scholar 

  • 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(8):622–626

    Article  CAS  PubMed  Google Scholar 

  • Keller J, Layer P (2008) Idiopathic chronic pancreatitis. Best Pract Res Clin Gastroenterol 22(1):105–113

    Article  CAS  PubMed  Google Scholar 

  • Lankisch PG (1982) Exocrine pancreatic function tests. Gut 23(9):777–798

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Lankisch PG (1993) Function tests in the diagnosis of chronic pancreatitis. Critical evaluation. Int J Pancreatol 14(1):9–20

    CAS  PubMed  Google Scholar 

  • Lankisch PG, Löhr-Happe A, Otto J, Creutzfeldt W (1993) Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion 54(3):148–155

    Article  CAS  PubMed  Google Scholar 

  • Lankisch PG, Seidensticker F, Löhr-Happe A, Otto J, Creutzfeldt W (1995) The course of pain is the same in alcohol- and nonalcohol-induced chronic pancreatitis. Pancreas 10(4):338–341

    Article  CAS  PubMed  Google Scholar 

  • Lankisch PG, Schmidt I, König H, Lehnick D, Knollmann R, Löhr M, Liebe S (1998) Faecal elastase 1: not helpful in diagnosing chronic pancreatitis associated with mild to moderate exocrine pancreatic insufficiency. Gut 42(4):551–554

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • 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(5):1481–1487

    Article  CAS  PubMed  Google Scholar 

  • Lembcke B, Braden B, Caspary WF (1996) Exocrine pancreatic insufficiency: accuracy and clinical value of the uniformly labelled 13C-Hiolein breath test. Gut 39(5):668–674

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Leodolter A, Kahl S, Domínguez-Muñoz JE, Gerards C, Glasbrenner B, Malfertheiner P (2000) Comparison of two tubeless function tests in the assessment of mild-to-moderate exocrine pancreatic insufficiency. Eur J Gastroenterol Hepatol 12(12):1335–1338

    Article  CAS  PubMed  Google Scholar 

  • Levy P, Milan C, Pignon JP, Baetz A, Bernades P (1989) Mortality factors associated with chronic pancreatitis. Unidimensional and multidimensional analysis of a medical-surgical series of 240 patients. Gastroenterology 96(4):1165–1172

    CAS  PubMed  Google Scholar 

  • Lowenfels AB, Maisonneuve P, Cavallini G, Ammann RW, Lankisch PG, Andersen JR et al (1994) Prognosis of chronic pancreatitis: an international multicenter study. International Pancreatitis Study Group. Am J Gastroenterol 89(9):1467–1471

    CAS  PubMed  Google Scholar 

  • Mahlke R, Lübbers H, Lankisch PG (2005) Diagnostik und Therapie der chronischen Pankreatitis. Internist (Berl) 46(2):145–156

    Article  CAS  Google Scholar 

  • Malfertheiner P, Pieramico O, Büchler M, Ditschuneit H (1990) Relationship between pancreatic function and pain in chronic pancreatitis. Acta Chir Scand 156(4):267–270; discussion 270–271

    CAS  PubMed  Google Scholar 

  • Mitchell RMS, Byrne MF, Baillie J (2003) Pancreatitis. Lancet 361(9367):1447–1455

    Article  CAS  PubMed  Google Scholar 

  • Mössner J (2011) Update lecture: benign diseases of the exocrine pancreas. Dig Dis 29(Suppl 1):9–16

    Article  PubMed  Google Scholar 

  • Mullady DK, Yadav D, Amann ST, O'Connell MR, Barmada MM, Elta GH et al (2011) Type of pain, pain-associated complications, quality of life, disability and resource utilisation in chronic pancreatitis: a prospective cohort study. Gut 60(1):77–84

    Article  PubMed  Google Scholar 

  • Müllhaupt B, Truninger K, Ammann R (2005) Impact of etiology on the painful early stage of chronic pancreatitis: a long-term prospective study. Z Gastroenterol 43(12):1293–1301

    Article  PubMed  Google Scholar 

  • Nealon WH, Thompson JC (1993) Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression. A longitudinal prospective analysis of the modified puestow procedure. Ann Surg 217(5):458–466; discussion 466–468

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Newcomer AD, Hofmann AF, DiMagno EP, Thomas PJ, Carlson GL (1979) Triolein breath test: a sensitive and specific test for fat malabsorption. Gastroenterology 76(1):6–13

    CAS  PubMed  Google Scholar 

  • Park DH, Kim M-H, Chari ST (2009) Recent advances in autoimmune pancreatitis. Gut 58(12):1680–1689

    Article  CAS  PubMed  Google Scholar 

  • Pickartz T, Mayerle J, Lerch MM (2007) Autoimmune pancreatitis. Nat Clin Pract Gastroenterol Hepatol 4(6):314–323

    Article  CAS  PubMed  Google Scholar 

  • Rebours V, Boutron-Ruault M-C, Jooste V, Bouvier A-M, Hammel P, Ruszniewski P, Lévy P (2009) Mortality rate and risk factors in patients with hereditary pancreatitis: uni- and multidimensional analyses. Am J Gastroenterol 104(9):2312–2317

    Article  PubMed  Google Scholar 

  • Rosendahl J, Bödeker H, Mössner J, Teich N (2007) Hereditary chronic pancreatitis. Orphanet J Rare Dis 2:1

    Article  PubMed Central  PubMed  Google Scholar 

  • Sarner M, Cotton PB (1984) Classification of pancreatitis. Gut 25(7):756–759

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Sasikala M, Talukdar R, Pavan kumar P, Radhika G, Rao GV, Pradeep R et al (2012) β-Cell dysfunction in chronic pancreatitis. Dig Dis Sci 57(7):1764–1772

    Article  CAS  PubMed  Google Scholar 

  • Schneider A, Löhr JM, Singer MV (2007) The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol 42(2):101–119

    Article  PubMed  Google Scholar 

  • Siegmund E, Löhr JM, Schuff-Werner P (2004) Die diagnostische Validität nichtinvasiver Pankreasfunktionstests – Eine Metaanalyse. Z Gastroenterol 42(10):1117–1128

    Article  CAS  PubMed  Google Scholar 

  • Spanier BWM, Dijkgraaf MGW, Bruno MJ (2008) Epidemiology, aetiology and outcome of acute and chronic pancreatitis: an update. Best Pract Res Clin Gastroenterol 22(1):45–63

    Article  CAS  PubMed  Google Scholar 

  • Toskes PP, Hansell J, Cerda J, Deren JJ (1971) Vitamin B 12 malabsorption in chronic pancreatic insufficiency. N Engl J Med 284(12):627–632

    Article  CAS  PubMed  Google Scholar 

  • van der Gaag NA, van Gulik TM, Busch ORC, Sprangers MA, Bruno MJ, Zevenbergen C et al (2012) Functional and medical outcomes after tailored surgery for pain due to chronic pancreatitis. Ann Surg 255(4):763–770

    Article  PubMed  Google Scholar 

  • Vantrappen GR, Rutgeerts PJ, Ghoos YF, Hiele MI (1989) Mixed triglyceride breath test: a noninvasive test of pancreatic lipase activity in the duodenum. Gastroenterology 96(4):1126–1134

    CAS  PubMed  Google Scholar 

  • Ventrucci M, Cipolla A, Ubalducci GM, Roda A, Roda E (1998) 13C labelled cholesteryl octanoate breath test for assessing pancreatic exocrine insufficiency. Gut 42(1):81–87

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Weaver LT, Amarri S, Swart GR (1998) 13C mixed triglyceride breath test. Gut 43(Suppl 3):S13–S19

    Article  PubMed Central  PubMed  Google Scholar 

  • Witt H, Apte MV, Keim V, Wilson JS (2007) Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology 132(4):1557–1573

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    Kerstin Schütte

  2. Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    Peter Malfertheiner

Authors
  1. Peter Malfertheiner
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  2. Kerstin Schütte
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Correspondence to Peter Malfertheiner .

Editor information

Editors and Affiliations

  1. Medizinische Klinik I, Universitätsklinikum Schleswig-Hoslstein, Campus Lübeck, Lübeck, Schleswig-Holstein, Germany

    Hendrik Lehnert

  2. TU Dresden Universitätsklinikum Carl Gustav Carus, Dresden, Germany

    Sebastian M. Schellong

  3. FB Gastroenterologie und Hepatologie, Universitätsklinikum Leipzig Medizinische Klinik und Poliklinik II, Leipzig, Sachsen, Germany

    Joachim Mössner

  4. Krankenhaus Barmherzige Brüder, Regensburg, Germany

    Cornel C. Sieber

  5. Nürnberg, Bayern, Germany

    Walter Swoboda

  6. Universitätsklinikum Giessen und Marburg Klinik für Innere Medizin, Marburg, Hessen, Germany

    Andreas Neubauer

  7. Interdisziplinärer Schwerpunkt für Hämos, Universitätsklinikum Gießen und Marburg, Gießen, Germany

    Bettina Kemkes-Matthes

  8. Klinik für Gastroenterologie,Hepatologie, Medizinische Hochschule Hannover, Hannover, Germany

    Michael P. Manns

  9. Sektion für Molekulare und Klinische Inf, Universitätsklinikum Schleswig-Holstein,, Lübeck, Germany

    Jan Rupp

  10. Abt. Kardiologie und Pneumologie, Universitätsklinikum Göttingen Herzzentrum Göttingen, Göttingen, Germany

    Gerd Hasenfuß

  11. Abt. Nephrologie und Klinische Immunologie, Univ.Klinikum Aachen Medizinische Klinik II, Aachen, Germany

    J. Floege

  12. Universitätsklinikum Köln Klinik I für Innere Medizin, Köln, Germany

    Michael Hallek

  13. Klinik für Pneumologie, Medizinische Hochschule Hannover (MHH) Zentrum Innere Medizin, Hannover, Germany

    Tobias Welte

  14. Klinik u. Poliklinik für Innere Medizin, Universitätsmedizin Greifswald, Greifswald, Germany

    Markus Lerch

  15. Dr.-Horst-Schmidt-Kliniken GmbH, Wiesbaden, Germany

    Elisabeth Märker-Hermann

  16. Klinische Toxikologie, Giftinformation, Universitätsklinikum Mainz II. Medizinische Klinik und Poliklinik, Mainz, Germany

    Ludwig Sacha Weilemann

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Malfertheiner, P., Schütte, K. (2015). Chronische Pankreatitis: Klinik, Labordiagnostik und bildgebende Diagnostik. In: Lehnert, H., et al. DGIM Innere Medizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54676-1_113-1

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