Chronic pancreatitis: assessing the quality of life.

Chronic pancreatitis is a benign disease often characterized by recurrent episodes of abdominal pain accompanied by progressive pancreatic exocrine and endocrine insufficiency, and it sometimes requires multiple hospitalizations [1]. The disease is frequently the result of chronic alcohol abuse, even if, recently, other etiological factors have been postulated such as genetic alterations, autoimmune disorders and obstructive disease of the biliary tract and the pancreas [2]. The management of chronic pancreatitis remains a challenging puzzle. For most patients, medical treatment is a good option, especially in those requiring substitutive therapy for either exocrine or for endocrine insufficiency; however, controlling the pain remains the main therapeutic challenge. Although medical management of pain may be one of the therapeutic modalities [3], in the past as well as in the present, surgical management has been the main option in the case of intractable pain [4]. In recent years, other therapeutic options, more medical than surgical, have been applied in clinical practice: endoscopic therapy [5], thoracoscopic splanchnicectomy [6], and extracorporeal shockwave lithotripsy [7]. For many years, the success of the therapeutic modalities has been seen only from a medical point of view [8, 9, 10], but successful medical therapy reflects only one aspect of the multidimensional approach to these patients, which is also composed of the sensitive and functional aspects of day to day life. Health-related quality of life, subjectively perceived by the patient, is becoming a major issue in the evaluation of any therapeutic intervention, mainly in patients with chronic or hard to cure diseases, where the aim of the intervention is to keep patients either symptom free and able to live in the community for a long time or to reduce the discomfort caused by the disease. In particular, in chronic pancreatitis patients, only surgeons and endoscopists have explored the quality of life in relation to their interventional approaches, but only a few of them have used structured and validated furthermore, the time interval between the intervention and the assessment of the health-related quality of life was quite low in these studies ranging from 3 to 74 months. Many studies evaluating the quality of life in chronic pancreatitis have been published; these studies involved mixed medical-surgical patients [17, 18, 19, 20]. Three of these studies utilized a questionnaire called Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) [17, 18, 19] and the most recent study, a questionnaire constituted by two different modules, the …