만성 췌장염 환자의 대변 내 췌장 Elastase-1

이진헌,정재복,박윤희,서정훈,박승우,이세준,정준표,송시영,강진경 대한췌담도연구회 2000 대한췌담도연구회지 Vol.5 No.1

만성 췌장염의 임상적 연구

정문기,김창덕,현진해 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.2

만성 췌장염의 임상상, 자연경과 및 합병증

추진우 ( Jin Woo Choo ),문성훈 ( Sung-hoon Moon ) 대한췌담도학회 2017 대한췌담도학회지 Vol.22 No.2

만성 췌장염은 췌장에 꾸준히 진행되는 염증과 섬유화를 특징으로 하는 질환으로 주요 임상특징은 복통, 흡수불량, 영양실조, 당뇨병 및 췌장 석회화이다. 이전에는 급성 췌장염과 만성 췌장염이 분리되어 있는 별개의 질병으로 생각하였으나 현재는 급성 췌장염과 만성 췌장염은 같은 질병의 연속선상에 있는 것으로 여겨지고 있다. 그 근거로는 급성 췌장염과 만성 췌장염의 발병원인이 상당부분 비슷하며 급성 췌장염이 만성 췌장염으로 진행할 수 있기 때문이다. 최근의 연구에 의하면 급성 췌장염의 첫 번째 발생 환자의 10%에서 만성 췌장염이 발생하였고, 재발성 급성 췌장염 환자의 36%에서 만성 췌장염으로 진행하였으며 진행하는 위험인자는 흡연, 음주 그리고 남자 성별이었다. 만성 췌장염의 만성적인 심한 통증은 삶의 질을 떨어뜨리고 사회활동을 제한하는데 주요 기전은 1) 췌관이나 췌실질의 압력증가로 인한 허혈과 2) 말초 및 중추의 통각수용신경의 민감화이다. 만성 췌장염의 통증은 간헐적인 양상과 연속적인 양상이 있으며 연속적인 양상의 통증이 삶의 질을 더 떨어뜨리는 것으로 보고되었다. 만성 췌장염의 복통은 만성 췌장염의 유병기간이 증가하면서 췌장이 "burn out"되어서 통증이 없어진다는 보고도 있지만 유병기간이 길어져도 통증이 남아 있다는 보고도 있어서 추가적인 연구가 필요하다. 지방변은 췌장의 외분비기능이 10% 이하로 남아 있을 때 발생하게 되므로 많이 진행된 만성 췌장염에서 관찰되는데 외분비기능부전은 만성 췌장염 환자의 50-80%에서 나타날 수 있는 것으로 알려져 있다. 만성 췌장염에서 췌장의 내분비 조직의 파괴는 상대적으로 늦게 나타나는 것으로 알려져 있지만 오랜 기간 추적하였을 때 만성 췌장염 환자의 40-80%에서 당뇨병이 발생한다. 만성 췌장염과 연관된 당뇨병은 3c형 당뇨병으로 분류되며 췌장의 폴리펩티드 반응이 없는 것이 특징이다. 만성 췌장염 환자에서 당뇨병을 조기진단하기 위해서 해마다 공복 혈당과 당화혈색소를 측정하도록 권유한다. 가성낭종은 만성 췌장염 환자의 25% 정도에서 발생하며 가장 흔한 증상은 복통이며 가성동맥류와 같은 합병증이 발생할 수 있다. 가성동 맥류가 발견이 되면 출혈발생 여부와 관계없이 치료해야 한다. 담관 협착도 만성췌장염 환자의 10% 정도에서 발생하여서 간기능검사 이상, 황달, 담관염을 발생시킬수 있다. Chronic pancreatitis is a debilitating disease characterized by abdominal pain, exocrine insufficiency, and diabetes mellitus and has had great social, economic, and psychological impacts. Traditional definition of chronic pancreatitis has been based on irreversible histological findings such as self-sustaining chronic inflammation, fibrosis, and eventual destruction of ductal, exocrine, and endocrine tissues. In contrast, the traditional characteristics of acute pancreatitis have been thought as a complete recovery of pancreatic function and morphology during the convalescence period. Acute and chronic pancreatitis have been considered separated disease entities. However, the current idea regarding the natural course of pancreatitis is that acute pancreatitis can progress to the intermediate step of recurrent acute pancreatitis, and finally to chronic pancreatitis. This evolution can be characterized by a sequence of necrotic and fibrotic events, or described by sentinel acute pancreatitis event (SAPE) hypothesis. Therefore, chronic pancreatitis is better defined as a progressive inflammatory and fibrotic disease of the pancreas with clinical features of abdominal pain, malnutrition, diabetes mellitus and imaging features of pancreatic parenchymal/ ductal calcifications. The complications of chronic pancreatitis include pseudocyst, pseudoaneurysm, fistula, biliary stricture, and duodenal stricture. This review describes the progression from acute to chronic pancreatitis, the mechanisms and nature of abdominal pain, steatorrhea, pancreatogenic diabetes mellitus, pseudocyst, pseudoaneurysm, and biliary stricture associated with chronic pancreatitis. Korean J Pancreas Biliary Tract 2017;22(2):63-71

만성 췌장염에서 대변 Elastase 1 측정의 임상적 유용성

류지곤,김용태,윤용범,김정룡 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.32 No.4

만성 췌장염의 수술적 치료

한덕종 대한췌담도연구회 2003 대한췌담도연구회지 Vol.8 No.2

특집 : 만성 췌장염; 만성 췌장염의 수술적 치료

duckjonghan 대한췌담도학회 2003 대한췌담도학회지 Vol.8 No.2

Chronic pancreatitis is not primarily a surgical disease. However, surgical intervention is required more often than acute pancreatitis. The principal indications for operation in chronic pancreatitis are intractable abdominal pain not amenable to medical treatment, complicated chronic pan-creatitis such as bile duct obstruction, duodenal obstruction, large pseudocystm pancreatic ascites, hemorrhage and venous compression, and suspicion of pancreatic cancer. Preoperative assessment of patient`s condition and definement of symptoms related to pancreatitis are important as well as correction of alcohol or drug addition. In order to be a proper treatment in chronic pancreatitis, cooperative team approach among gastroenterologist, endocrinologist, radiologist, and surgeon can not be overemphasized. Final operative procedure will be selected by the experienced surgeon under the full understanding of patient`s condition. Resective procedure on chronic pancreatitis sometimes can be a more difficult one than cancer, due to severe peripancreatic fibrotic reaction. Save the some in dications for total pancreatectomy which cause inevitable endocrine and exocrine insufficiency, partial pancreatectomy, namely pancreatoduodenectomy can be used under the condition of lower postoperative morbidity and mortality. Again operative treatment can be a final treatment modality in chronic pancreatitis under the consensus of many specialists on pan-creatic disease and full understanding about the operation from the patient and relatives.

다발성 췌관석에 의한 만성 재발성 췌장염 1례

이승연,엄지현,정기섭,김명준,Lee, Seung -Yeon,Um, Ji-Hyun,Chung, Ki-Sup,Kim, Myung-Joon 대한소아소화기영양학회 2001 Pediatric gastroenterology, hepatology & nutrition Vol.4 No.2

저자들은 반복적으로 췌장염을 앓은 여아에서 상복부 동통을 주소로 내원하여 MRCP와 ERCP를 통해 다발성 췌관석이 원인인 만성 재발성 췌장염 1례를 치험하였기에 보고하는 바이다. Chronic pancreatitis is a rare problem in childhood and sometimes shows pancreatic calcification. The most common symptom is recurrent upper abdominal pain with or without associated nausea or vomiting. Pancreatic calcifications are virtually pathognomonic of chronic pancreatitis. In our case, however, chronic pancreatitis caused by multiple pancreatic stones in dilated pancreatic duct, which was very rare in childhood. Endoscopic retrograde cholangiopancreaticography (ERCP) is valuable in confirming the diagnosis and decision making process for further medical or surgical management of pancreatic disease. We experienced a case of chronic relapsing pancreatitis with pancreatic stones in 13-year-old girl who presented with recurrent upper abdominal pain. She was investigated with ERCP and treated by endoscopic sphincterotomy of sphincter of Oddi and by some stone removal with endoscopic basket. We report this case and review related literatures briefly.

가족 SPINK1 N34S 유전자 변이가 확인된 만성 췌장염 1예

오형철 ( Hyoung Chul Oh ),이태윤 ( Tae Yoon Lee ),권승현 ( Seung Hyun Kwon ),이상수 ( Sang Soo Lee ),서동완 ( Dong Wan Seo ),이성구 ( Sung Koo Lee ),김명환 ( Myung Hwan Kim ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.6

New insight in the field of chronic pancreatitis was provided by the discovery of protease serine 1 (PRSS1) mutation, inherited by autosomal dominant trait in hereditary pancreatitis. Serine protease inhibior, Kazal type 1(SPINK1) is a potent protease inhibitor which prevents premature intrapancreatic activation of trypsin and pancreatic autodigestion. Strong associations of SPINK1 mutation and different forms of pancreatitis were suggested. However, it is unlikely that SPINK1 mutation alone can cause chronic pancreatitis. This mutation acts as a disease-modifier or plays a role within polygenic or multifactorial models. A 23 year-old young woman with chronic pancreatitis was recently discovered to have SPINK1 N34S heterozygous mutation cosegregated with two intronic mutations, IVS1-37T>C and IVS3-69insTTTT, during the evaluation for potential cause of chronic idiopathic pancreatitis. The same mutation was identified in her mother. This is the first report in Korea suggesting that SPINK1 mutation would be a possible cause of chronic pancreatitis in a patient with familial background. (Korean J Gastroenterol 2007;49:384-389)

Total Cholesterol Level for Assessing Pancreatic Insufficiency Due to Chronic Pancreatitis

( Kenji Hirano ),( Tomotaka Saito ),( Suguru Mizuno ),( Minoru Tada ),( Naoki Sasahira ),( Hiroyuki Isayama ),( Miho Matsukawa ),( Gyotane Umefune ),( Dai Akiyama ),( Kei Saito ),( Shuhei Kawahata ),( 대한소화기학회 2014 Gut and Liver Vol.8 No.5

Background/Aims: To determine the nutritional markers important for assessing the degree of pancreatic insufficiency due to chronic pancreatitis in routine clinical practice. Methods: A total of 137 patients with chronic pancreatitis were followed up for more than 1 year. They were divided into two groups: a pancreatic diabetes mellitus (DM) group, consisting of 47 patients undergoing medical treatment for DM of pancreatic origin, and a nonpancreatic DM group, consisting of 90 other patients (including 86 patients without DM). Serum albumin, prealbumin, total cholesterol, cholinesterase, magnesium, and hemoglobin were compared between the two groups. Results: The total cholesterol was significantly lower in the pancreatic than the nonpancreatic DM group (164 mg/dL vs 183 mg/dL, respectively; p=0.0028). Cholinesterase was significantly lower in the former group (263 U/L vs 291 U/L, respectively; p=0.016). Among the 37 patients with nonalcoholic pancreatitis, there was no difference in the cholinesterase levels between the pancreatic and nonpancreatic (296 U/L vs 304 U/L, respectively; p=0.752) DM groups, although cholesterol levels remained lower in the former (165 mg/dL vs 187 mg/dL, respectively; p=0.052). Conclusions: Cholinesterase levels are possibly affected by concomitant alcoholic liver injury. The total cholesterol level should be considered when assessing pancreatic insufficiency due to chronic pancreatitis. (Gut Liver 2014;8:563-568)

ORiginal Article : Association between Smoking and the Progression of Computed Tomography Findings in Chronic Pancreatitis

( Jeong Woo Lee ),( Ho Gak Kim ),( Dong Wook Lee ),( Jimin Han ),( Hyuk Yong Kwon ),( Chang Jin Seo ),( Ji Hye Oh ),( Joo Hyoung Lee ),( Jin Tae Jung ),( Joong Goo Kwon ),( Eun Young Kim ) 대한간학회 2016 Gut and Liver Vol.10 No.3

Background/Aims: Smoking and alcohol intake are two wellknown risk factors for chronic pancreatitis. However, there are few studies examining the association between smoking and changes in computed tomography (CT) findings in chronic pancreatitis. The authors evaluated associations between smoking, drinking and the progression of calcification on CT in chronic pancreatitis. Methods: In this retrospective study, 59 patients with chronic pancreatitis who had undergone initial and follow-up CT between January 2002 and September 2010 were included. Progression of calcification among CT findings was compared according to the amount of alcohol intake and smoking. Results: The median duration of followup was 51.6 months (range, 17.1 to 112.7 months). At initial CT findings, there was pancreatic calcification in 35 patients (59.3%). In the follow-up CT, progression of calcification was observed in 37 patients (62.7%). Progression of calcification was more common in smokers according to the multivariate analysis (odds ratio [OR], 9.987; p=0.006). The amount of smoking was a significant predictor for progression of calcification in the multivariate analysis (OR, 6.051 in less than 1 pack per day smokers; OR, 36.562 in more than 1 pack per day smokers; p=0.008). Conclusions: Continued smoking accelerates pancreatic calcification, and the amount of smoking is associated with the progression of calcification in chronic pancreatitis. (Gut Liver 2016;10:464-469)