Chronic Pancreatitis
By Steven Freedman, M.D., PhD.
Since the first description of chronic pancreatitis over 200 years ago, there have been relatively few advances in our understanding and treatment of this disease. Generally, the goal has been to “rest” the pancreas by minimizing oral intake and treating the pain with medication. Several exciting new developments have been described over the past year. Our group has focused on understanding chronic pancreatitis and developing novel effective treatments.
Approximately 40% of adult cases of chronic pancreatitis have no known cause and are thus labeled “idiopathic.” Cystic fibrosis, a genetic disorder that routinely causes pancreatic insufficiency in children, can produce recurrent attacks of pancreatitis. Recent studies have shown that at least 30% of adult patients with unexplained chronic pancreatitis, have mutations in the cystic fibrosis gene. Our group, in collaboration with researchers at The Hospital For Sick Children in Toronto, is currently enrolling patients for more extensive studies of this gene. Preliminary results suggest that the incidence of gene mutations may be much higher. Interestingly, these patients have no other evidence of cystic fibrosis such as recurrent pneumonia. This genetic research may lead to the development of a simpler test to diagnose chronic pancreatitis and help prevent the many procedures patients undergo. In addition, this may lead to novel treatments.
Related work in our laboratory has uncovered how a mutation in the cystic fibrosis gene may lead to disease. Based on these results, we have discovered a new oral agent which significantly corrects the abnormalities in mice where the cystic fibrosis gene has been deleted. With the current support of the Cystic Fibrosis Foundation, our goal is to advance this research in order to proceed to clinical trials in patients.
Lastly, in an ongoing research study, we have addressed the issue of nutrition in patients with chronic pancreatitis. We have found that administration of a specific nutritional supplement helps treat the pain in a subgroup of patients. This appears to work by minimizing stimulation of the pancreas while providing adequate calories to prevent malnutrition. In addition, its antioxidant properties may block inflammation in the pancreas. In some instances, this has eliminated the need for total parenteral nutrition.
Steven D. Freedman, M.D., PhD., is Director of the Pancreas Center Division of Gastroenterology, Beth Isreal Deaconess Hospital, Boston and Director of the National Pancreas Foundation.
