Aliment Pharmacol Ther 2011; 33: 149–159 Summary Background Effectiveness of medical therapies in chronic pancreatitis has been described in small studies of selected patients. Aim To describe frequency and perceived effectiveness of non‐analgesic medical therapies in chronic pancreatitis patients evaluated at US referral centres. Methods Using data on 516 chronic pancreatitis patients enrolled prospectively in the NAPS2 Study, we evaluated how often medical therapies [pancreatic enzyme replacement therapy (PERT), vitamins/antioxidants (AO), octreotide, coeliac plexus block (CPB)] were utilized and considered useful by physicians. Results Oral PERT was commonly used (70%), more frequently in the presence of exocrine insufficiency (EI) (88% vs. 61%, P < 0.001) and pain (74% vs. 59%, P < 0.002). On multivariable analyses, predictors of PERT usage were EI (OR 5.14, 95% CI 2.87–9.18), constant (OR 3.42, 95% CI 1.93–6.04) or intermittent pain (OR 1.98, 95% CI 1.14–3.45). Efficacy of PERT was predicted only by EI (OR 2.16, 95% CI 1.36–3.42). AO were tried less often (14%) and were more effective in idiopathic and obstructive vs. alcoholic chronic pancreatitis (25% vs. 4%, P = 0.03). Other therapies were infrequently used (CPB – 5%, octreotide – 7%) with efficacy generally <50%. Conclusions Pancreatic enzyme replacement therapy is commonly utilized, but is considered useful in only subsets of chronic pancreatitis patients. Other medical therapies are used infrequently and have limited efficacy.

Background: A major complication of severe acute pancreatitis is the vascular leak syndrome, which can result in intravascular volume depletion and adult respiratory distress syndrome. Angiopoietin-2 is an endothelial cell autocrine peptide, released by local injury and leading to destabilization of endothelial cells with increased vascular permeability. Aim: To assess serum levels of Angiopoietin-2 in patients with AP and their role as predictor of disease severity. Methods: A cohort of 185 patients with acute pancreatitis was prospectively enrolled between June 2003 and September 2007. Demographic information, clinical features, DNA and daily serum samples were collected. Patients were classified into mild (79%) and severe acute pancreatitis (21%) based on the presence of organ failure. Angiopoietin-2 levels were measured in previously frozen serum samples from patients on days 2-7 from onset of pain and controls. Angiopoietin-2 levels were compared with clinical outcomes using Naïve Bayes and logistic ridge regression to generate statistical models predicting disease severity. Results: Angiopoietin-2 levels were measured in 93 patient serum samples on Days 2-7 and 58 controls. Angiopoietin-2 levels were significantly higher in patients with severe acute pancreatitis compared to mild acute pancreatitis and control subjects on all days. Using logistic ridge regression the highest accuracy was on day 2 (84%) with an area under the curve of 0.76 as a predictive statistical model for disease severity. Conclusions: In AP significantly elevated angiopoietin-2 levels are strongly associated with organ failure and disease severity. Angiopoietin-2 levels early in the course of the disease appear to accurately predict a severe course.