D0016 - Clinical Characterization of the Silent Chronic Pancreatitis Patient

Mark Bundschuh, MD¹, Hadie Razjouyan, MD¹, Matthew Coates, MD¹, August Stuart, MS¹, Vonn Walter, PhD¹, John Levenick, MD², Charles Dye, MD¹, Jennifer Maranki, MD¹, Abraham Mathew, MD¹, Matthew T. Moyer, MD, MS¹, Brandon Headlee, PA-C^1
1Penn State Hershey Medical Center, Hershey, PA; ²Penn State College of Medicine, Hershey, PA

Introduction: “Silent”, or painless, chronic pancreatitis (CP) exists when patients with diagnostic features of CP describe no abdominal pain. It is a poorly understood phenomenon but it is important as it may go unnoticed until serious complications arise, including pancreatic insufficiency, diabetes, and even cancer. The aim of this study was to better characterize the silent CP patient and investigate potential risk factors associated with this condition.

Methods: We performed a retrospective analysis using data from a single tertiary care center between 2018-2021. 286 patients were identified using ICD-10 codes (“other chronic pancreatitis”-K86.1 and “exocrine pancreatic insufficiency”-K86.81). Two expert reviewers assessed each patient. Patients were included if they demonstrated feature(s) of CP including parenchymal (atrophy, calcifications +/- scarring) and/or ductal (stricture +/- dilation) changes on CT, MRI, or EUS imaging. Patients were excluded if their pain was attributed to a cause other than CP or if they underwent prior pancreaticobiliary surgery. Patients were categorized as having painful or silent CP, based upon documentation from at least two clinic visits. Patient demographics, CP etiology, presence of pancreatic duct stent & diabetes, substance use, and pain medication usage were abstracted. Descriptive statistics, bivariate and logistic regression analyses (utilizing variables with a p< 0.1 on bivariate analysis) were performed to characterize the study cohort and evaluate for independent associations with silent CP.

Results: 117 patients with CP were included in this study (mean age 57.2 years, 61.5% male). 23 patients (19.7%) had silent CP (Table 1). Patients with silent CP were older, more likely male, more likely diabetic, and less likely to use opioids or any pain medications (Table 1). On multivariate analysis, older age (OR 1.06, 95% CI 1.01-1.11, p=0.03), male sex (OR 5.38, 95% CI 1.38-20.96, p=0.02), and opioid use (OR 0.18, 95% CI 0.03-0.96, p=0.04) were associated with silent CP (Table 2).

Discussion: Silent CP is relatively common and affected patients are older, more likely male, and less likely to use opioids. This suggests there may be inherent differences in visceral pain perception contributing to this clinical phenotype. Future studies should focus on evaluating larger cohorts longitudinally to confirm our findings and to more carefully investigate the underlying pathophysiology of silent CP, as well as to evaluate clinical outcomes of this condition.


Disclosures:


Mark Bundschuh, MD¹, Hadie Razjouyan, MD¹, Matthew Coates, MD¹, August Stuart, MS¹, Vonn Walter, PhD¹, John Levenick, MD², Charles Dye, MD¹, Jennifer Maranki, MD¹, Abraham Mathew, MD¹, Matthew T. Moyer, MD, MS¹, Brandon Headlee, PA-C¹. D0016 - Clinical Characterization of the Silent Chronic Pancreatitis Patient, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.