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CLINICAL STUDIES OF CASES OF CLINICALLY SUSPECTED CHRONIC PANCREATITIS

We often encounter patients who have uncertain complaints in the upper abdominal quadrant characteristic of back pain and epigastralgia. Some of these patients show only hyperamylasuria, expressed as hourly amylase secretion for seven consecutive days, without abnormality in upper gastroendoscopy, abdominal ultrasound examination and other diagnostic imaging tests. We studied the clinical features of these patients and endoscopic manometry of the pancreatic duct and the papillary zone to elucidate the mechanism of these complaints and the hyperamylasuria.The subjects were 62 patients (male 37, female 25, mean age 43.7) who visited the Isesaki Municipal Hospital. All these patients with uncertain complaints in the upper abdominal quadrant showed only hyperamylasuria and no abnormality of the upper gastrointestinal tract, liver, biliary tract and pancreas on the diagnostic imaging. No cases underwent abdominal surgery. Back pain and epigastralgia were experienced in 59.7% and 58.1% respectively. The C. M. I. (Cornell Medical Index) test was given in 19 of the patients. Class III and IV, which indicate of neurotic tendency, were found in 4 and 5 patients respectively.Manometric study of the pancreatic duct and papillary zone was performed endoscopically, using a 4 Fr microtransducer (Gaeltec Ltd.).In the patients, pancreatic duct pressure, peak pressure, basal pressure, frequency and duration were 10.17±4.84mmHg, 118.80±40.95mmHg, 10.65±4.31mmHg, 5.35±3.15/min, and 5.13 ± 1. 09sec, comparing with 4.75±2.00mmHg, 70.00±16.60mmHg, 6.24±2.82mmHg, 6.28 ± 2.88/min, and 4.75 ± 1.27sec, respectively, in the control group. Pancreatic duct pressure, peak pressure and basal pressure were significantly different (P <0.01, Student's t-test) from the control.From these results, we suspected that the uncertain complaints in the upper abdominal quadrant and hyperamylasuria of these patients may be related to abnormal function of the papillary zone and high pressure in the pancreatic duct.