Chronic Gastrointestinal Dysmotility and Pain Following Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis

George K. John, Vikesh Singh, Robert A. Moran, Daniel Warren, Zhao Li Sun, Niraj M Desai, Christi Walsh, Rita R. Kalyani, Erica Hall, Kenzo Hirose, Martin A Makary, Ellen Stein

Research output: Contribution to journalArticle

Abstract

Background: The prevalence and impact of chronic gastrointestinal dysmotility following total pancreactectomy with islet autotransplantation (TP-IAT) for chronic pancreatitis is not known. Methods: A cross-sectional study of all patients who underwent TP-IAT at our institution from August 2011 to November 2015 was undertaken. The GCSI (Gastroparesis Cardinal Symptom Index), PAGI-SYM (Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index), PAC-SYM (Patient Assessment of Constipation Symptoms), Bristol stool chart, 12-item Short Form Health Survey (SF-12), and visual analog scale for pain were administered ≥4 weeks following TP-IAT. Key Results: The prevalence of any dysmotility symptoms in patients who completed the survey (33/45, 73%) post-TP-IAT was 45%. Post-TP-IAT, the mean reduction in opioid dosing was 77.6 oral morphine equivalents (OMEs) (95% CI 32.1–123.0, p = 0.002) with 42% of patients requiring no opioids. There was significant negative correlation between dysmotility scores and SF-12 physical scores (r = −0.46, p = 0.008, 95% CI −0.70 to −0.13). Self-reported abdominal pain had significant negative correlation with both physical and mental SF-12 scores (r = −0.67, p < 0.001, 95% CI −0.83 to −0.41 and r = −0.39, p = 0.03, 95% CI −0.65 to −0.04). There was no correlation between gastrointestinal dysmotility and self-reported pain. Conclusions and Inferences: Symptoms of chronic gastrointestinal dysmotility and chronic abdominal pain are common post-TP-IAT and will need to be better recognized and differentiated to improve the management of these patients.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 12 2017

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Pancreatectomy
Autologous Transplantation
Chronic Pancreatitis
Pain
Abdominal Pain
Opioid Analgesics
Gastroparesis
Symptom Assessment
Pain Measurement
Constipation
Health Surveys
Chronic Pain
Morphine
Cross-Sectional Studies

Keywords

  • Chronic pancreatitis
  • Post-TP-IAT dysmotility
  • QOL

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{8d4ec210dac0474383b35f583db31d4d,
title = "Chronic Gastrointestinal Dysmotility and Pain Following Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis",
abstract = "Background: The prevalence and impact of chronic gastrointestinal dysmotility following total pancreactectomy with islet autotransplantation (TP-IAT) for chronic pancreatitis is not known. Methods: A cross-sectional study of all patients who underwent TP-IAT at our institution from August 2011 to November 2015 was undertaken. The GCSI (Gastroparesis Cardinal Symptom Index), PAGI-SYM (Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index), PAC-SYM (Patient Assessment of Constipation Symptoms), Bristol stool chart, 12-item Short Form Health Survey (SF-12), and visual analog scale for pain were administered ≥4 weeks following TP-IAT. Key Results: The prevalence of any dysmotility symptoms in patients who completed the survey (33/45, 73{\%}) post-TP-IAT was 45{\%}. Post-TP-IAT, the mean reduction in opioid dosing was 77.6 oral morphine equivalents (OMEs) (95{\%} CI 32.1–123.0, p = 0.002) with 42{\%} of patients requiring no opioids. There was significant negative correlation between dysmotility scores and SF-12 physical scores (r = −0.46, p = 0.008, 95{\%} CI −0.70 to −0.13). Self-reported abdominal pain had significant negative correlation with both physical and mental SF-12 scores (r = −0.67, p < 0.001, 95{\%} CI −0.83 to −0.41 and r = −0.39, p = 0.03, 95{\%} CI −0.65 to −0.04). There was no correlation between gastrointestinal dysmotility and self-reported pain. Conclusions and Inferences: Symptoms of chronic gastrointestinal dysmotility and chronic abdominal pain are common post-TP-IAT and will need to be better recognized and differentiated to improve the management of these patients.",
keywords = "Chronic pancreatitis, Post-TP-IAT dysmotility, QOL",
author = "John, {George K.} and Vikesh Singh and Moran, {Robert A.} and Daniel Warren and Sun, {Zhao Li} and Desai, {Niraj M} and Christi Walsh and Kalyani, {Rita R.} and Erica Hall and Kenzo Hirose and Makary, {Martin A} and Ellen Stein",
year = "2017",
month = "1",
day = "12",
doi = "10.1007/s11605-016-3348-z",
language = "English (US)",
pages = "1--6",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",

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TY - JOUR

T1 - Chronic Gastrointestinal Dysmotility and Pain Following Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis

AU - John, George K.

AU - Singh, Vikesh

AU - Moran, Robert A.

AU - Warren, Daniel

AU - Sun, Zhao Li

AU - Desai, Niraj M

AU - Walsh, Christi

AU - Kalyani, Rita R.

AU - Hall, Erica

AU - Hirose, Kenzo

AU - Makary, Martin A

AU - Stein, Ellen

PY - 2017/1/12

Y1 - 2017/1/12

N2 - Background: The prevalence and impact of chronic gastrointestinal dysmotility following total pancreactectomy with islet autotransplantation (TP-IAT) for chronic pancreatitis is not known. Methods: A cross-sectional study of all patients who underwent TP-IAT at our institution from August 2011 to November 2015 was undertaken. The GCSI (Gastroparesis Cardinal Symptom Index), PAGI-SYM (Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index), PAC-SYM (Patient Assessment of Constipation Symptoms), Bristol stool chart, 12-item Short Form Health Survey (SF-12), and visual analog scale for pain were administered ≥4 weeks following TP-IAT. Key Results: The prevalence of any dysmotility symptoms in patients who completed the survey (33/45, 73%) post-TP-IAT was 45%. Post-TP-IAT, the mean reduction in opioid dosing was 77.6 oral morphine equivalents (OMEs) (95% CI 32.1–123.0, p = 0.002) with 42% of patients requiring no opioids. There was significant negative correlation between dysmotility scores and SF-12 physical scores (r = −0.46, p = 0.008, 95% CI −0.70 to −0.13). Self-reported abdominal pain had significant negative correlation with both physical and mental SF-12 scores (r = −0.67, p < 0.001, 95% CI −0.83 to −0.41 and r = −0.39, p = 0.03, 95% CI −0.65 to −0.04). There was no correlation between gastrointestinal dysmotility and self-reported pain. Conclusions and Inferences: Symptoms of chronic gastrointestinal dysmotility and chronic abdominal pain are common post-TP-IAT and will need to be better recognized and differentiated to improve the management of these patients.

AB - Background: The prevalence and impact of chronic gastrointestinal dysmotility following total pancreactectomy with islet autotransplantation (TP-IAT) for chronic pancreatitis is not known. Methods: A cross-sectional study of all patients who underwent TP-IAT at our institution from August 2011 to November 2015 was undertaken. The GCSI (Gastroparesis Cardinal Symptom Index), PAGI-SYM (Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index), PAC-SYM (Patient Assessment of Constipation Symptoms), Bristol stool chart, 12-item Short Form Health Survey (SF-12), and visual analog scale for pain were administered ≥4 weeks following TP-IAT. Key Results: The prevalence of any dysmotility symptoms in patients who completed the survey (33/45, 73%) post-TP-IAT was 45%. Post-TP-IAT, the mean reduction in opioid dosing was 77.6 oral morphine equivalents (OMEs) (95% CI 32.1–123.0, p = 0.002) with 42% of patients requiring no opioids. There was significant negative correlation between dysmotility scores and SF-12 physical scores (r = −0.46, p = 0.008, 95% CI −0.70 to −0.13). Self-reported abdominal pain had significant negative correlation with both physical and mental SF-12 scores (r = −0.67, p < 0.001, 95% CI −0.83 to −0.41 and r = −0.39, p = 0.03, 95% CI −0.65 to −0.04). There was no correlation between gastrointestinal dysmotility and self-reported pain. Conclusions and Inferences: Symptoms of chronic gastrointestinal dysmotility and chronic abdominal pain are common post-TP-IAT and will need to be better recognized and differentiated to improve the management of these patients.

KW - Chronic pancreatitis

KW - Post-TP-IAT dysmotility

KW - QOL

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