Specialized Procedure May Rid Chronic Pancreatitis Pain
Published March 2008
Thirteen. That's how many desperate trips Linda Conley made to an emergency room in Lexington, Ky., seeking relief for excruciating pain in her abdomen after she had her gallbladder removed in November 2003.
"I was in so much pain for so long that I couldn't function as a normal human being anymore. I had to quit my job," she recalls. "My doctor didn't have a solution, so he referred me to a pain management center."
Still, the specialists couldn't rid Conley of the mysterious pain. As she says: "The doctors just gave me pain medication and sent me home again."
Fighting a daily battle with nausea, she was soon subsisting on Jell-o as the pain tortured her body. After losing 50 pounds and nearly all her strength, she was beginning to lose hope.
Then serendipity struck.
Through a friend of a friend, Conley met a woman who had been treated for pancreatitis at the UC Pancreatic Disease Center (PDC).
The multidisciplinary clinic focuses exclusively on gastrointestinal and pancreatic diseases. It is also one of only two major centers in the United States that offer pancreatectomy (pancreas removal) with autologous islet cell transplant to treat chronic pancreatitis (inflammation of the pancreas).
Conley immediately set up an appointment with Andres Gelrud, MD, a UC gastroenterologist, who diagnosed the source of her pain-chronic pancreatitis-and offered a solution to alleviate it.
"None of my previous doctors ever offered a solution or cure for my pancreatitis," Conley says. "Now I knew the source of my pain, and had a medical team who could do something about it."
In November 2004, she had surgery to remove part of her pancreas-known as a Whipple procedure. It seemed to work until April 2006 when the pain came back and became progressively worse.
By April 2007, her doctors at the PDC told her the pancreatitis was so severe a pancreatectomy with autologous islet cell transplant was her best chance of eradicating the pain for good.
Syed Ahmad, MD, codirector of the PDC, says there are two goals of surgery: to decrease abdominal pain, thereby improving the patient's quality of life, and to reduce insulin dependence and/or gain glycemic control.
"Patients with chronic pancreatitis are quite debilitated. Most patients are on two to four short- and long-acting narcotics for pain by the time they get to us and-for the most part-are addicted to these medications," explains Ahmad, assistant professor and surgeon who performed Conley's pancreatectomy.
"Even after the source of the pain is removed, many patients still perceive pain because their bodies are programmed to need these medications."
Because of this, he says, it usually takes about a month to wean patients off their pain medications or reduce them to an acceptable level.
"In our experience, 60 to 70 percent of patients can be taken off all pain medications," adds Ahmad. "This is extraordinary, considering that most of our patients have been taking narcotics for pain management for years."
The UC team recently completed its 100th autologous islet cell transplant procedure at University Hospital. UC began offering the procedure in 1999 when Horacio Rilo, MD, who serves as director of cellular therapies for surgery, came to Cincinnati.
UC is one of only two major centers in the United States regularly performing the procedure, and has one of the largest number of autologous islet cell transplant experiences in the world.
Located behind the lower part of the stomach, the pancreas is a small organ that produces insulin and enzymes that help the body process and use food. It creates clusters of cells called the islets of langerhans, which are made of several types of cells including insulin-producing beta cells. This hormone helps the body use glucose for energy.
If the body doesn't make enough insulin or has trouble using it properly-causing glucose to build up in the blood-the patient will develop diabetes, requiring strict dietary changes or insulin injections.
During a pancreatectomy with autologous islet cell transplantation, the patient's pancreas is completely removed and taken to a laboratory where specialized enzymes are used to remove islet cells from the organ. The cells are then purified, processed and infused back into the patient through a vein in the liver.
"When we transplant islets, we transplant not only cells that make insulin but also cells making glucagon and pancreatic polypeptide," explains Rilo, associate professor of surgery. "Success is defined as insulin independence and stable, easy-to-control diabetes."
The UC team says 40 percent of patients do not need insulin injections following the islet cell transplantation procedure; the remaining 60 percent require minimal to moderate amounts of injected insulin.
"Once implanted, the beta cells in the islets begin to make and release insulin," explains Rilo. "These cells are very fragile, so the entire process is very time-sensitive."
Less than a year after surgery, Conley says she's enjoying life again-especially spending time with her 2-year-old grandson, Adam.
"After the surgery and transplant, the pain was gone. I feel human again and my body is regaining strength," she says. "I don't think I'd be alive today if I hadn't made it to the doctors at UC."
Her daughter, Tonja Elrod, says she's thankful to have her mom back.
"Mom was always healthy, so it wasn't just hard on her when she got sick-it was hard on the family," Elrod says. "After the surgery, her quality of life improved. She can enjoy the simple pleasures again-like eating a nice meal, shopping and spending time with family."
About the UC_Pancreatic Disease Center (PDC)
Pancreatic diseases require a specialized medical team-gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, radiation oncologists, radiologists and cellular transplantation surgeons-who work together to find solutions to complex health problems.
Since its opening in 2001, the PDC has become a national leader in the treatment of pancreatic diseases, including pancreatic cancer. Syed Ahmad, MD, estimates the center treats 200 patients annually.
The comprehensive team, which meets weekly to guide the treatment of each patient, includes gastroenterologists Andres Gelrud, MD, Shailendra Chauhan, MD, and Nathan Schmulewitz, MD; medical oncologist Malek Safa, MD; radiologists Kyruan Choe, MD, and Jonathan Moulton, MD; radiation oncologists William Barrett, MD, and David Grisell, MD; nurse Lori Haggerty; islet cell transplantation expert Horacio Rilo, MD; and surgeons Jeffrey Sussman, MD, and Ahmad.
Additional support for the PDC is provided by the departments of pathology and laboratory medicine and nutrition services.
For more information, visit ucpancreas.org or call (513) 584-CURE.