Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings

C. Mel Wilcox, Dhiraj Yadav, Tian Ye, Timothy B. Gardner, Andres Gelrud, Bimaljit S. Sandhu, Michele D. Lewis, Samer Al-Kaade, Gregory A. Cote, Christopher E. Forsmark, Nalini M. Guda, Darwin L. Conwell, Peter A. Banks, Thiruvengadam Muniraj, Joseph Romagnuolo, Randall E. Brand, Adam Slivka, Stuart Sherman, Stephen R. Wisniewski, David C. WhitcombMichelle A. Anderson

Research output: Contribution to journalArticlepeer-review

127 Scopus citations


Background & Aims: Chronic pancreatitis is characterized by inflammation, atrophy, fibrosis with progressive ductal changes, and functional changes that include variable exocrine and endocrine insufficiency and multiple patterns of pain. We investigated whether abdominal imaging features accurately predict patterns of pain. Methods: We collected data from participants in the North American Pancreatitis Study 2 Continuation and Validation, a prospective multicenter study of patients with chronic pancreatitis performed at 13 expert centers in the United States from July 2008 through March 2012. Chronic pancreatitis was defined based on the detection of characteristic changes by cross-sectional abdominal imaging, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, or histology analyses. Patients were asked by a physician or trained clinical research coordinator if they had any abdominal pain during the year before enrollment, those who responded "yes" were asked to select from a list of 5 pain patterns. By using these patterns, weclassified patients' pain based on timing and severity. Abnormal pancreatitis-associated features on abdominal imaging were recorded using standardized case report forms. Results: Data were collected from 518 patients (mean age, 52 ± 14.6 y; 55% male and 87.6% white). The most common physician-identified etiologies were alcohol (45.8%) and idiopathic (24.3%); 15.6% of patients reported no abdominal pain in the year before enrollment. The most common individual pain pattern was described as constant mild pain with episodes of severe pain and was reported in 45% of patients. The most common imaging findings included pancreatic ductal dilatation (68%), atrophy (57%), and calcifications (55%). Imaging findings were categorized as obstructive for 20% and as inflammatory for 25% of cases. The distribution of individual imaging findings was similar among patients with different patterns of pain. The distribution of pain patterns did not differ among clinically relevant groups of imaging findings. Conclusions: Mechanisms that determine patterns and severity of pain in patients with chronic pancreatitis are largely independent of structural variants observed by abdominal imaging techniques. Pancreas-relevant quantitative and qualitative pain measures should be included in the evaluation of patients with chronic pancreatitis to assess pain severity independently of imaging findings.

Original languageEnglish
Pages (from-to)552-560
Number of pages9
JournalClinical Gastroenterology and Hepatology
Issue number3
StatePublished - Mar 1 2015

Bibliographical note

Funding Information:
Funding Supported by grants R01DK061451 (D.C.W.), R01 DK077906 (D.Y.), and UL1 RR024153 from the National Center for Research Resources , a component of the National Institutes of Health , and the National Institutes of Health Roadmap for Medical Research .

Publisher Copyright:
© 2015 AGA Institute.


  • Abdominal imaging
  • Abdominal pain
  • Chronic pancreatitis
  • NAPS2-CV

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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