Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2023, 167(2):157-161 | DOI: 10.5507/bp.2023.019

Painless form of chronic pancreatitis - multicentre study

Petr Dite^{1, 2}, Marie Precechtelova¹, Martina Bojkova^{2, 3}, Martin Lovecek⁴, Radek Ambroz⁴, Arnost Martinek^{2, 3}, Jiri Dolina^{1, 5}

¹ Department of Gastroenterology and Internal Medicine, University Hospital Brno, Czech Republic

² Faculty of Medicine, University of Ostrava, Czech Republic

³ Internal Cardiology Clinic - Department of Gastroenterology, University Hospital Ostrava, Czech Republic

⁴ Department of Surgery I, University Hospital Olomouc, Czech Republic

⁵ Faculty of Medicine, Masaryk University, Brno, Czech Republic

Background: The painless form of chronic pancreatitis is one of the rarer forms of the disease. While 80% to 90% of all chronic pancreatitis cases have abdominal pain as their clinical symptom, a smaller proportion of persons with chronic pancreatitis do not report typical pain. This form of the disease is often associated with exocrine and endocrine pancreatic insufficiency and weight loss, but the absence of pain symptoms may initially lead to misdiagnosis.

Methods: In a cohort of 257 people with chronic pancreatitis, the painless form was diagnosed in 30 individuals (11.6%), with an average age of 56 years and a predominance of men (71.4%). Thirty-eight percent were non-smokers and 47.6% of patients smoked up to 10 cigarettes per day. Alcohol intake of less than 40 g per day was reported by 61.9% of subjects. A quarter were moderately overweight, with a mean BMI of 26.5. Newly diagnosed diabetes mellitus had 25.7% of the subjects.

Results: A frequent finding was the demonstration of morphological changes, with calcifications found in 85,7% and dilatation of the pancreatic duct greater than 6.0 mm in 66%. A surprising finding was the presence of metabolic syndrome in 42.8% and the most frequent finding was the demonstration of decreased external pancreatic secretion (90%).

Conclusion: Painless chronic pancreatitis is usually treated conservatively. We demonstrate a subset of 28 patients with painless chronic pancreatitis treated surgically. Most frequent indications were benign stenosis of the intrapancreatic bile duct and stenosis of the pancreatic duct. Although approximately 1 in 10 people with chronic pancreatitis present with a painless form of it, so that the form of the disease is described as rare, this does not change the fact that management of these people is still not optimal.

Keywords: pancreatic pain, painless form of pancreatitis, diabetes mellitus, pancreatic calcifications, exocrine insufficiency

Received: April 4, 2023; Revised: April 25, 2023; Accepted: May 5, 2023; Prepublished online: May 22, 2023; Published: June 12, 2023  Show citation