The natural history of pain in alcoholic chronic pancreatitis Rudolf W. Ammann, Beat Muellhaupt  Gastroenterology  Volume 116, Issue 5, Pages 1132-1140 (May 1999) DOI: 10.1016/S0016-5085(99)70016-8 Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 1 Schematic representation of the two typical pain patterns in ACP. A-type pain pattern is characterized by short (usually ≤10 days) relapsing pain episodes separated by pain-free intervals of several months to ≥1 year. The intermittent pain episodes may either be severe, requiring hospitalization (H) (as is typical for acute pancreatitis), or mild and transient, manageable by the patient with short-term intake of nonnarcotic analgesics. B-type pain is characterized by prolonged periods of either persistent (daily) and/or clusters of recurrent severe pain exacerbations. Typically severe pain occurs 2 or more days per week for at least 2 months and requires repeated hospitalizations in most instances. Gastroenterology 1999 116, 1132-1140DOI: (10.1016/S0016-5085(99)70016-8) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 2 Cumulative rate of surgery in relation to onset of ACP. The first surgical procedure (□) for severe pain was necessary in 116 patients, mainly in early-stage ACP (in 75% ≤6 years after onset). A second procedure (■) for severe pain recurrences was necessary in 39 patients (34%) 5.5–7 years after the first procedure. Gastroenterology 1999 116, 1132-1140DOI: (10.1016/S0016-5085(99)70016-8) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 3 Probability of remaining free from pain recurrence for nonsurgical (––––) and surgical (....) patients. Gastroenterology 1999 116, 1132-1140DOI: (10.1016/S0016-5085(99)70016-8) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 4 Probability of remaining free of exocrine insufficiency for nonsurgical (––––) and surgical (....) patients. A fecal chymotrypsin value of >120 μg/g is indicative of normal exocrine function. Gastroenterology 1999 116, 1132-1140DOI: (10.1016/S0016-5085(99)70016-8) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 5 Probability of remaining free of diabetes mellitus for nonsurgical (––––) and surgical (....) patients. Gastroenterology 1999 116, 1132-1140DOI: (10.1016/S0016-5085(99)70016-8) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 6 Probability of remaining free of calcification for nonsurgical (––––) and surgical (....) patients. Gastroenterology 1999 116, 1132-1140DOI: (10.1016/S0016-5085(99)70016-8) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 7 Changes in body weight (in kg ± 95% confidence interval) from (A) onset to (D) final weight at the end of follow-up. An initial weight loss occurred in the early phase (A and B: P < 0.0001 in surgical and nonsurgical series), probably related to pain (B). A transient weight gain is noted in an intermediate phase, probably primarily due to arrest of pain (C) (B and C, P < 0.0001 in surgical and nonsurgical series). In advanced or end-stage ACP, a marked weight loss occurred, probably related to diabetes and/or steatorrhea (D) (C and D: P < 0.0001 in surgical and nonsurgical series). There was no significant difference in weight between the surgical and nonsurgical series at any stage of the disease. □, Nonsurgical; ●, surgical. Gastroenterology 1999 116, 1132-1140DOI: (10.1016/S0016-5085(99)70016-8) Copyright © 1999 American Gastroenterological Association Terms and Conditions