Pancreatitis is a condition wherein the pancreas becomes inflamed. Amongst the two forms of pancreatitis: acute and chronic, the latter one constitutes long lasting inflammation. Major cause of chronic pancreatitis is damage to pancreas due to heavy alcohol consumption. Hereditary disorders of the pancreas, gall stones, high triglycerides, cystic fibrosis and certain medications are the various other causes responsible for chronic pancreatitis. Children are rarely known to be affected by chronic pancreatitis, but incidences may occur in case of genetic mutations or trauma to the pancreas though the cause is not completely known. Various tests are available to diagnose chronic pancreatitis which include pancreatic function test, pancreas exocrine function test, CT scans, abdominal ultrasound examination, magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound, genetic testing and endoscopic retrograde cholangiopancreatography (ERCP).
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Constant pain in the upper abdomen radiating to the back is the most common symptom associated with chronic pancreatitis. Other symptoms are nausea, vomiting, weight loss due to malabsorption of food, steatorrhea and diabetes if the insulin producing cells are damaged. Two major reasons contributing to the pain in chronic pancreatitis are increased pressure in the pancreatic ducts and inflammation of pancreatic nerve. Inflammation of pancreas causes narrowing of the pancreatic duct, thus causing blockage. This leads to building up of pancreatic secretions in the pancreatic duct, consequently leading to pain.
The global chronic pancreatitis pain market can be segmented based on therapy type, and geography. Therapies used to treat chronic pancreatitis pain include medical therapy, endoscopic therapy and surgery. Medical therapy is the first line of treatment in chronic pain management and may be further classified as nonspecific supportive therapy, pancreatic enzymes, octreotide, and antioxidant therapy. Analgesic drugs are the most commonly used method to treat the concurrent symptoms as a supportive therapy. In some cases, antidepressants and anti inflammatory drugs are also used as a concomitant therapy. The use of oral pancreatic enzymes has been variable. These enzymes replace the normally produced pancreatic enzymes; however, these enzymes are not known to be effective in all people. Octreotide are cholecystokinin-receptor antagonists that inhibit pancreatic secretion and thus is known to be effective in reducing the chronic pain.
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Endoscopic therapy is used to overcome pancreatic duct obstruction caused due to strictures, stones or ampullary stenosis, though endoscopic treatments are more used to prevent acute relapsing of pancreatitis. Currently, endoscopic insertion of stents is known to have potential use in chronic pancreatitis. Various pain modifying agents such as gabapentin, antidepressants, and pregabalin, antioxidants, celiac plexus block, octreotide and total pancreatectomy with islet cell auto transplantation are currently undergoing extensive research. Nerve block involves injecting directly into the nerves responsible for transmitting pain signals from the pancreas. Pancreatic lithotripsy is the procedure used to break up stones lodged in the pancreatic duct. This helps to improve the flow of digestive juices. Surgery is recommended only when the individual does not respond to other treatments. These surgical procedures include pancreaticojejunostomy to remove blockage and pressure in the pancreatic duct, removal of part of the pancreas and an experimental treatment known as autologous islet transplantation.
Geographically, the chronic pancreatitis pain market can be categorized into four major regions namely North America, Europe, Asia Pacific and Rest of the World. Some of the key players contributing to the global chronic pancreatitis pain market are Abbott, Aptalis Pharma, Inc., McNeil Consumer Healthcare and Sun Biopharma while various institutions involved in the research for treating chronic pancreatitis pain include Radboud University, University Medicine Greifswald, and University of Albama.