In chronic pancreatitis, the presentation again can be a little bit variable, but what we want to see is that it's a combination of both their clinical presentation as well as their imaging findings, and we see that there should be some abnormal imaging findings that go along with what you're seeing clinically, usually ductal irregularities, calcifications, or pancreatic gland atrophy.
Obviously if they're pancreatic exocrine insufficient and you put them on PET, they're bloating, their other GI symptoms may improve. A low fat diet is a healthier diet. Sometimes that is helpful with their symptoms as well, but there's no evidence that any of these interventions really prevent recurrent pancreatitis or pancreatic pain episodes.
Unfortunately, the data doesn't hold true to that. So there have been multiple trials that have looked at a number of interventions to try and see if we can prevent recurrent pancreatitis episodes or pancreas pain episodes, and unfortunately, low fat diet, PETs, antioxidants, and steroids have never been shown to prevent those episodes.
until you really understand the true phenotype of the patient and their genotype, you're not going to be able to identify which patients are going to be able to be enrolled into a trial
Patients can certainly have acute recurrent pancreatitis and not have the evidence of ductile changes or pancreatic atrophy or pancreatic function loss.
patients can certainly have acute recurrent pancreatitis and not have the evidence of ductile changes or pancreatic atrophy or pancreatic function loss
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 3 · 1:43
quoterecurrent pancreatitis and chronic pancreatitis are essentially the same thing↗
▶Ep 3 · 2:54
epidemiologicalBetween 7 and 34% of pediatric patients with acute pancreatitis will eventually develop recurrent episodes of pancreatitis↗
▶Ep 3 · 3:12
guidelineAcute recurrent pancreatitis is defined as two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes↗
▶Ep 3 · 3:37
guidelineChronic pancreatitis requires a combination of clinical presentation and abnormal imaging findings including ductal irregularities, calcifications, or pancreatic gland atrophy↗
▶Ep 3 · 5:48
quotepatients can certainly have acute recurrent pancreatitis and not have the evidence of ductile changes or pancreatic atrophy or pancreatic function loss↗
▶Ep 3 · 5:48
clinicalPatients can have acute recurrent pancreatitis without evidence of ductal changes, pancreatic atrophy, or pancreatic function loss↗
▶Ep 3 · 5:59
quoteWhat leads them, tips them over the edge, what takes them from having acute recurrent pancreatitis to actually then developing chronic pancreatitis↗
▶Ep 3 · 9:46
quotein a 10-year-old who was previously healthy, this is, this is a very atypical finding↗
▶Ep 3 · 11:37
epidemiologicalIn pediatric populations, the main risk factors for chronic pancreatitis are genetic, followed by obstructive or anatomic processes↗
▶Ep 3 · 11:37
epidemiologicalIn adults, alcohol causes up to 70% of chronic pancreatitis cases↗
▶Ep 3 · 20:56
clinicalThe CF Foundation has an extensive pipeline of small molecules to optimize CFTR function, particularly for atypical mutations↗
▶Ep 3 · 21:37
quoteuntil you really understand the true phenotype of the patient and their genotype, you're not going to be able to identify which patients are going to be able to be enrolled into a trial↗
▶Ep 3 · 36:40
clinicalLow fat diet, pancreatic enzyme replacement therapy, antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes↗
▶Ep 3 · 36:40
quotelow fat diet, PETs, antioxidants, and steroids have never been shown to prevent those episodes↗
Joe's statements about Acute Recurrent Pancreatitis10 statements
Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease
▶Ep 4 · 1:33
quoteselecting the right patient is probably as critical as doing the surgery itself↗
▶Ep 4 · 5:28
quotethe main indication is chronic pain, unresponsive to optical, medical, and endoscopic approaches↗
▶Ep 4 · 5:28
guidelineTPIAT is indicated for chronic pain unresponsive to optimal medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes, repeated admissions, missed school or work.↗
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 6 · 5:48
quotePatients can certainly have acute recurrent pancreatitis and not have the evidence of ductile changes or pancreatic atrophy or pancreatic function loss.↗
▶Ep 6 · 5:48
clinicalPatients can have acute recurrent pancreatitis without evidence of ductal changes, pancreatic atrophy, or pancreatic function loss.↗
▶Ep 6 · 11:37
epidemiologicalIn the pediatric cohort, the main risk factors for chronic pancreatitis were genetic, followed by obstructive or anatomic processes.↗
▶Ep 6 · 20:56
quoteThe CF Foundation actually has a very extensive pipeline of small molecules that they're using for patients that that optimize CFTR function. And so this is especially true for some of the atypical mutations.↗
▶Ep 6 · 20:56
clinicalThe CF Foundation has an extensive pipeline of small molecules optimizing CFTR function, which may offer therapeutic options for pancreatitis patients with CFTR mutations.↗
▶Ep 6 · 37:02
quoteObviously if they're pancreatic exocrine insufficient and you put them on PET, they're bloating, their other GI symptoms may improve. A low fat diet is a healthier diet. Sometimes that is helpful with their symptoms as well, but there's no evidence that any of these interventions really prevent recurrent pancreatitis or pancreatic pain episodes.↗
▶Ep 6 · 37:02
clinicalPancreatic enzyme replacement may improve bloating and other GI symptoms in patients with exocrine insufficiency, but does not prevent attacks.↗
Joe's statements about Chronic Pancreatitis10 statements
Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease
▶Ep 4 · 1:33
quoteselecting the right patient is probably as critical as doing the surgery itself↗
▶Ep 4 · 5:28
guidelineTPIAT is indicated for chronic pain unresponsive to optimal medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes, repeated admissions, missed school or work.↗
▶Ep 4 · 5:28
quotethe main indication is chronic pain, unresponsive to optical, medical, and endoscopic approaches↗
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 2 · 5:48
clinicalPatients can have acute recurrent pancreatitis without evidence of ductal changes, pancreatic atrophy, or pancreatic function loss.↗
▶Ep 2 · 5:48
quotePatients can certainly have acute recurrent pancreatitis and not have the evidence of ductile changes or pancreatic atrophy or pancreatic function loss.↗
▶Ep 2 · 11:37
epidemiologicalIn the pediatric cohort, the main risk factors for chronic pancreatitis were genetic, followed by obstructive or anatomic processes.↗
▶Ep 2 · 20:56
quoteThe CF Foundation actually has a very extensive pipeline of small molecules that they're using for patients that that optimize CFTR function. And so this is especially true for some of the atypical mutations.↗
▶Ep 2 · 20:56
clinicalThe CF Foundation has an extensive pipeline of small molecules optimizing CFTR function, which may offer therapeutic options for pancreatitis patients with CFTR mutations.↗
▶Ep 2 · 37:02
quoteObviously if they're pancreatic exocrine insufficient and you put them on PET, they're bloating, their other GI symptoms may improve. A low fat diet is a healthier diet. Sometimes that is helpful with their symptoms as well, but there's no evidence that any of these interventions really prevent recurrent pancreatitis or pancreatic pain episodes.↗
▶Ep 2 · 37:02
clinicalPancreatic enzyme replacement may improve bloating and other GI symptoms in patients with exocrine insufficiency, but does not prevent attacks.↗
Joe's statements about Islet Cell / TPIAT6 statements
Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease
▶Ep 2 · 1:33
quoteselecting the right patient is probably as critical as doing the surgery itself↗
▶Ep 2 · 1:33
quoteselecting the right patient is probably as critical as doing the surgery itself↗
▶Ep 2 · 5:28
guidelineTPIAT is indicated for chronic pain unresponsive to optimal medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes, repeated admissions, missed school or work.↗
▶Ep 2 · 5:28
quotethe main indication is chronic pain, unresponsive to optical, medical, and endoscopic approaches↗
▶Ep 2 · 5:28
guidelineTPIAT is indicated for chronic pain unresponsive to optimal medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes, repeated admissions, missed school or work.↗
▶Ep 2 · 5:28
quotethe main indication is chronic pain, unresponsive to optical, medical, and endoscopic approaches↗
Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease
▶Ep 9 · 1:33
quoteselecting the right patient is probably as critical as doing the surgery itself↗
▶Ep 9 · 1:33
quoteselecting the right patient is probably as critical as doing the surgery itself↗
▶Ep 9 · 5:28
guidelineTPIAT is indicated for chronic pain unresponsive to optimal medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes, repeated admissions, missed school or work.↗
▶Ep 9 · 5:28
quotethe main indication is chronic pain, unresponsive to optical, medical, and endoscopic approaches↗
▶Ep 9 · 5:28
guidelineTPIAT is indicated for chronic pain unresponsive to optimal medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes, repeated admissions, missed school or work.↗
▶Ep 9 · 5:28
quotethe main indication is chronic pain, unresponsive to optical, medical, and endoscopic approaches↗
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 4 · 2:54
epidemiologicalBetween 7 and 34% of pediatric patients with acute pancreatitis will eventually develop recurrent episodes.↗
▶Ep 4 · 2:54
quoteBetween 7 and 34% of pediatric patients will eventually develop recurrent episodes of pancreatitis.↗
▶Ep 4 · 3:12
guidelineAcute recurrent pancreatitis is defined as two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes.↗
▶Ep 4 · 3:12
quoteThe definition for acute recurrent pancreatitis is again two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes.↗
▶Ep 4 · 3:37
quoteIn chronic pancreatitis, the presentation again can be a little bit variable, but what we want to see is that it's a combination of both their clinical presentation as well as their imaging findings, and we see that there should be some abnormal imaging findings that go along with what you're seeing clinically, usually ductal irregularities, calcifications, or pancreatic gland atrophy.↗
▶Ep 4 · 3:37
guidelineChronic pancreatitis requires a combination of clinical presentation and abnormal imaging findings: ductal irregularities, calcifications, or pancreatic gland atrophy, seen on CT, MRCP, or ERCP.↗
▶Ep 4 · 4:30
guidelineChronic pancreatitis diagnosis also requires abdominal pain consistent with pancreatic origin or evidence of endocrine or exocrine pancreatic insufficiency.↗
▶Ep 4 · 5:48
quotePatients can certainly have acute recurrent pancreatitis and not have the evidence of ductile changes or pancreatic atrophy or pancreatic function loss.↗
▶Ep 4 · 5:48
clinicalPatients can have acute recurrent pancreatitis without evidence of ductal changes, pancreatic atrophy, or pancreatic function loss.↗
▶Ep 4 · 5:48
quotePatients can certainly have acute recurrent pancreatitis and not have the evidence of ductile changes or pancreatic atrophy or pancreatic function loss.↗
▶Ep 4 · 5:48
clinicalPatients can have acute recurrent pancreatitis without evidence of ductal changes, pancreatic atrophy, or pancreatic function loss.↗
▶Ep 4 · 11:37
epidemiologicalIn adults, up to 70% of chronic pancreatitis cases are caused by alcohol.↗
▶Ep 4 · 11:37
epidemiologicalIn the pediatric cohort, the main risk factors for chronic pancreatitis were genetic, followed by obstructive or anatomic processes.↗
▶Ep 4 · 11:37
quoteIn adults where you see predominantly alcohol as the cause of chronic pancreatitis, with up to 70% of patients with chronic pancreatitis being caused by alcohol, the main risk factors for our patient population were were genetic, and then the second most common risk factor was an obstructive process or an anatomic process.↗
▶Ep 4 · 11:37
epidemiologicalIn the pediatric cohort, the main risk factors for chronic pancreatitis were genetic, followed by obstructive or anatomic processes.↗
▶Ep 4 · 20:56
quoteThe CF Foundation actually has a very extensive pipeline of small molecules that they're using for patients that that optimize CFTR function. And so this is especially true for some of the atypical mutations.↗
▶Ep 4 · 20:56
clinicalThe CF Foundation has an extensive pipeline of small molecules optimizing CFTR function, which may offer therapeutic options for pancreatitis patients with CFTR mutations.↗
▶Ep 4 · 20:56
quoteThe CF Foundation actually has a very extensive pipeline of small molecules that they're using for patients that that optimize CFTR function. And so this is especially true for some of the atypical mutations.↗
▶Ep 4 · 20:56
clinicalThe CF Foundation has an extensive pipeline of small molecules optimizing CFTR function, which may offer therapeutic options for pancreatitis patients with CFTR mutations.↗
▶Ep 4 · 36:40
clinicalLow-fat diet, pancreatic enzyme replacement, antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes.↗
▶Ep 4 · 36:40
quoteUnfortunately, the data doesn't hold true to that. So there have been multiple trials that have looked at a number of interventions to try and see if we can prevent recurrent pancreatitis episodes or pancreas pain episodes, and unfortunately, low fat diet, PETs, antioxidants, and steroids have never been shown to prevent those episodes.↗
▶Ep 4 · 37:02
clinicalPancreatic enzyme replacement may improve bloating and other GI symptoms in patients with exocrine insufficiency, but does not prevent attacks.↗
▶Ep 4 · 37:02
clinicalPancreatic enzyme replacement may improve bloating and other GI symptoms in patients with exocrine insufficiency, but does not prevent attacks.↗
▶Ep 4 · 37:02
quoteObviously if they're pancreatic exocrine insufficient and you put them on PET, they're bloating, their other GI symptoms may improve. A low fat diet is a healthier diet. Sometimes that is helpful with their symptoms as well, but there's no evidence that any of these interventions really prevent recurrent pancreatitis or pancreatic pain episodes.↗
▶Ep 4 · 37:02
quoteObviously if they're pancreatic exocrine insufficient and you put them on PET, they're bloating, their other GI symptoms may improve. A low fat diet is a healthier diet. Sometimes that is helpful with their symptoms as well, but there's no evidence that any of these interventions really prevent recurrent pancreatitis or pancreatic pain episodes.↗
Summaries Joe gave as host
· 33 summaries
Recaps of other experts' statements, not Joe's own clinical position.
Summaries Joe gave as host · Acute Recurrent Pancreatitis11 summaries
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 6 · 2:54
host summaryJoe Palermo summarizing the discussion: Between 7 and 34% of pediatric patients with acute pancreatitis will eventually develop recurrent episodes.↗
▶Ep 6 · 2:54
host summaryJoe Palermo summarizing the discussion: Between 7 and 34% of pediatric patients will eventually develop recurrent episodes of pancreatitis.↗
▶Ep 6 · 3:12
host summaryJoe Palermo summarizing the discussion: Acute recurrent pancreatitis is defined as two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes.↗
▶Ep 6 · 3:12
host summaryJoe Palermo summarizing the discussion: The definition for acute recurrent pancreatitis is again two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes.↗
▶Ep 6 · 3:37
host summaryJoe Palermo summarizing the discussion: In chronic pancreatitis, the presentation again can be a little bit variable, but what we want to see is that it's a combination of both their clinical presentation as well as their imaging findings, and we see that there should be some abnormal imaging findings that go along with what you're seeing clinically, usually ductal irregularities, calcifications, or pancreatic gland atrophy.↗
▶Ep 6 · 3:37
host summaryJoe Palermo summarizing the discussion: Chronic pancreatitis requires a combination of clinical presentation and abnormal imaging findings: ductal irregularities, calcifications, or pancreatic gland atrophy, seen on CT, MRCP, or ERCP.↗
▶Ep 6 · 4:30
host summaryJoe Palermo summarizing the discussion: Chronic pancreatitis diagnosis also requires abdominal pain consistent with pancreatic origin or evidence of endocrine or exocrine pancreatic insufficiency.↗
▶Ep 6 · 11:37
host summaryJoe Palermo summarizing the discussion: In adults, up to 70% of chronic pancreatitis cases are caused by alcohol.↗
▶Ep 6 · 11:37
host summaryJoe Palermo summarizing the discussion: In adults where you see predominantly alcohol as the cause of chronic pancreatitis, with up to 70% of patients with chronic pancreatitis being caused by alcohol, the main risk factors for our patient population were were genetic, and then the second most common risk factor was an obstructive process or an anatomic process.↗
▶Ep 6 · 36:40
host summaryJoe Palermo summarizing the discussion: Low-fat diet, pancreatic enzyme replacement, antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes.↗
▶Ep 6 · 36:40
host summaryJoe Palermo summarizing the discussion: Unfortunately, the data doesn't hold true to that. So there have been multiple trials that have looked at a number of interventions to try and see if we can prevent recurrent pancreatitis episodes or pancreas pain episodes, and unfortunately, low fat diet, PETs, antioxidants, and steroids have never been shown to prevent those episodes.↗
Summaries Joe gave as host · Chronic Pancreatitis11 summaries
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 2 · 2:54
host summaryJoe Palermo summarizing the discussion: Between 7 and 34% of pediatric patients with acute pancreatitis will eventually develop recurrent episodes.↗
▶Ep 2 · 2:54
host summaryJoe Palermo summarizing the discussion: Between 7 and 34% of pediatric patients will eventually develop recurrent episodes of pancreatitis.↗
▶Ep 2 · 3:12
host summaryJoe Palermo summarizing the discussion: The definition for acute recurrent pancreatitis is again two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes.↗
▶Ep 2 · 3:12
host summaryJoe Palermo summarizing the discussion: Acute recurrent pancreatitis is defined as two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes.↗
▶Ep 2 · 3:37
host summaryJoe Palermo summarizing the discussion: In chronic pancreatitis, the presentation again can be a little bit variable, but what we want to see is that it's a combination of both their clinical presentation as well as their imaging findings, and we see that there should be some abnormal imaging findings that go along with what you're seeing clinically, usually ductal irregularities, calcifications, or pancreatic gland atrophy.↗
▶Ep 2 · 3:37
host summaryJoe Palermo summarizing the discussion: Chronic pancreatitis requires a combination of clinical presentation and abnormal imaging findings: ductal irregularities, calcifications, or pancreatic gland atrophy, seen on CT, MRCP, or ERCP.↗
▶Ep 2 · 4:30
host summaryJoe Palermo summarizing the discussion: Chronic pancreatitis diagnosis also requires abdominal pain consistent with pancreatic origin or evidence of endocrine or exocrine pancreatic insufficiency.↗
▶Ep 2 · 11:37
host summaryJoe Palermo summarizing the discussion: In adults where you see predominantly alcohol as the cause of chronic pancreatitis, with up to 70% of patients with chronic pancreatitis being caused by alcohol, the main risk factors for our patient population were were genetic, and then the second most common risk factor was an obstructive process or an anatomic process.↗
▶Ep 2 · 11:37
host summaryJoe Palermo summarizing the discussion: In adults, up to 70% of chronic pancreatitis cases are caused by alcohol.↗
▶Ep 2 · 36:40
host summaryJoe Palermo summarizing the discussion: Low-fat diet, pancreatic enzyme replacement, antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes.↗
▶Ep 2 · 36:40
host summaryJoe Palermo summarizing the discussion: Unfortunately, the data doesn't hold true to that. So there have been multiple trials that have looked at a number of interventions to try and see if we can prevent recurrent pancreatitis episodes or pancreas pain episodes, and unfortunately, low fat diet, PETs, antioxidants, and steroids have never been shown to prevent those episodes.↗
Summaries Joe gave as host · Pancreatitis11 summaries
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
▶Ep 4 · 2:54
host summaryJoe Palermo summarizing the discussion: Between 7 and 34% of pediatric patients will eventually develop recurrent episodes of pancreatitis.↗
▶Ep 4 · 2:54
host summaryJoe Palermo summarizing the discussion: Between 7 and 34% of pediatric patients with acute pancreatitis will eventually develop recurrent episodes.↗
▶Ep 4 · 3:12
host summaryJoe Palermo summarizing the discussion: Acute recurrent pancreatitis is defined as two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes.↗
▶Ep 4 · 3:12
host summaryJoe Palermo summarizing the discussion: The definition for acute recurrent pancreatitis is again two distinct episodes of acute pancreatitis with either complete resolution between episodes or complete normalization of enzymes between episodes.↗
▶Ep 4 · 3:37
host summaryJoe Palermo summarizing the discussion: In chronic pancreatitis, the presentation again can be a little bit variable, but what we want to see is that it's a combination of both their clinical presentation as well as their imaging findings, and we see that there should be some abnormal imaging findings that go along with what you're seeing clinically, usually ductal irregularities, calcifications, or pancreatic gland atrophy.↗
▶Ep 4 · 3:37
host summaryJoe Palermo summarizing the discussion: Chronic pancreatitis requires a combination of clinical presentation and abnormal imaging findings: ductal irregularities, calcifications, or pancreatic gland atrophy, seen on CT, MRCP, or ERCP.↗
▶Ep 4 · 4:30
host summaryJoe Palermo summarizing the discussion: Chronic pancreatitis diagnosis also requires abdominal pain consistent with pancreatic origin or evidence of endocrine or exocrine pancreatic insufficiency.↗
▶Ep 4 · 11:37
host summaryJoe Palermo summarizing the discussion: In adults, up to 70% of chronic pancreatitis cases are caused by alcohol.↗
▶Ep 4 · 11:37
host summaryJoe Palermo summarizing the discussion: In adults where you see predominantly alcohol as the cause of chronic pancreatitis, with up to 70% of patients with chronic pancreatitis being caused by alcohol, the main risk factors for our patient population were were genetic, and then the second most common risk factor was an obstructive process or an anatomic process.↗
▶Ep 4 · 36:40
host summaryJoe Palermo summarizing the discussion: Unfortunately, the data doesn't hold true to that. So there have been multiple trials that have looked at a number of interventions to try and see if we can prevent recurrent pancreatitis episodes or pancreas pain episodes, and unfortunately, low fat diet, PETs, antioxidants, and steroids have never been shown to prevent those episodes.↗
▶Ep 4 · 36:40
host summaryJoe Palermo summarizing the discussion: Low-fat diet, pancreatic enzyme replacement, antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes.↗
