Evoluation of pain in chronic relapsing pancreatitis: a study of operated and nonoperated patients.

A group of 191 patients with chronic relapsing pancreatitis was followed for about 10 years. Ninety-three of them were selected for surgery because of incapacitating painful relapses or persistent pain and were submitted to side-to-side pancreaticojejunostomy. Ninety-eight were selected for medical management. Seventeen patients died during the follow-up. The cumulative probability of pain relief, 10 years after clinical onset of the disease was 62.9% in the patients who had been submitted to surgery and 42.8% in the nonoperated patients. In the operated group, no case of further relapse was observed after a 3-year pain-free interval, but in the nonoperated group some patients complained of further painful relapses. Complete and lasting alcohol withdrawal and/or steatorrhea were significantly associated with a more favorable result in the patients who had been submitted to surgery. However, the relationship between alcohol consumption, exocrine pancreatic insufficiency, and pain behavior did not reach statistical significance in the nonoperated patients. In patients selected for and submitted to surgery, whose disease before surgery was severe because of a high frequency of painful relapses, the chance of pain relief was similar to, and to some extent higher than, that observed in patients not selected for surgery and suffering from a mild or moderate disease. Alcohol withdrawal and exocrine pancreatic insufficiency have been confirmed as being adjunctive factors toward lessening pain in patients who had been submitted to pancreaticojejunostomy.