GINOP - STAY ALIVE(GINOP-2.3.2-15-2016-00048) Támogató: Nemzeti Kutatási, Fejlesztési
és Innovációs Hivatal
Molmedex- I-KOM-TEAMING az intercelluláris kommunikáció szerepe a határfelületek immunológiai
és ...(GINOP-2.3.2-15-2016-00015) Támogató: GINOP
(ÚNKP-20-3)
University of Pécs Medical School Research Fund(300909)
Szakterületek:
Gasztroenterológia és hepatológia
Orvos- és egészségtudomány
Introduction Pain is the most common symptom in acute pancreatitis (AP) and is among
the diagnostic criteria. Therefore, we aimed to characterize acute abdominal pain
in AP. Methods The Hungarian Pancreatic Study Group prospectively collected multicentre
clinical data on 1435 adult AP patients between 2012 and 2017. Pain was characterized
by its intensity (mild or intense), duration prior to admission (hours), localization
(nine regions of the abdomen) and type (sharp, dull or cramping). Results 97.3% of
patients (n = 1394) had pain on admission. Of the initial population with acute abdominal
pain, 727 patients answered questions about pain intensity, 1148 about pain type,
1134 about pain localization and 1202 about pain duration. Pain was mostly intense
(70%, n = 511/727), characterized by cramping (61%, n = 705/1148), mostly starting
less than 24 h prior to admission (56.7%, n = 682/1202). Interestingly, 50.9% of the
patients (n = 577/1134) had atypical pain, which means pain other than epigastric
or belt-like upper abdominal pain. We observed a higher proportion of peripancreatic
fluid collection (19.5% vs. 11.0%; p = 0.009) and oedematous pancreas (8.4% vs. 3.1%;
p = 0.016) with intense pain. Sharp pain was associated with AP severity (OR = 2.481
95% CI: 1.550-3.969) and increased mortality (OR = 2.263, 95% CI: 1.199-4.059) compared
to other types. Longstanding pain (>72 h) on admission was not associated with outcomes.
Pain characteristics showed little association with the patient's baseline characteristics.
Conclusion A comprehensive patient interview should include questions about pain characteristics,
including pain type. Patients with sharp and intense pain might need special monitoring
and tailored pain management. Significance Acute abdominal pain is the leading presenting
symptom in acute pancreatitis; however, we currently lack specific guidelines for
pain assessment and management. In our cohort analysis, intense and sharp pain on
admission was associated with higher odds for severe AP and several systemic and local
complications. Therefore, a comprehensive patient interview should include questions
about pain characteristics and patients with intense and sharp pain might need closer
monitoring.
