In patients with big duct disease, pancreatic enzyme therapy is not very effective and may be beneficial in only 25% of patients. Following the principle feedback inhibition, it was proposed that octreotide, an analog of somatostatin, might be effective in controlling pain. Octreotide markedly inhibits pancreatic secretion and significantly lowers CCK levels. Several small short-term studies result in variable findings with regard to pain control with this agent. Results from a multicenter, double-blind, placebo-controlled, doseranging pilot study suggests that a dose of 200 ^g administered subcutaneously 3 times a day was effective. In that study of over 100 patients, 65% of patients showed a decrease in abdominal pain with that dose of octreotide and a decrease in anodyne (pain relief medication) usage. Not all patients respond to this agent, but it appears that those that respond are those that demonstrate at least a 50% reduction in blood CCK levels. Studies are now being launched from our laboratory that will be looking at a long acting form of octreotide that can be given once every 28 days in the dose equivalent to the 200 ^g 3 times a day (Draganov and Toskes, 2002). Thus in patients with small duct chronic pancreatitis, the treatment of choice should be nonenteric-coated pancreatic enzymes with a PPI. Treatment should be started and carried out for 4 to 6 weeks before an evaluation of success or failure has been made. If the patient fits all the criteria of small duct pancreatitis and is not benefiting from the enzyme approach described above, then a gastric emptying study should be done and, if there is gastroparesis, a prokinetic should be added to the plan.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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