Guideline for the diagnosis and treatment of chronic pancreatitis

BACKGROUND: Chronic pancreatitis (CP) is defined as a continuing inflammatory disease of the pancreas characterised by irreversible morphological changes, often associated with pain and with the loss of exocrine and/or endocrine function that may be clinically relevant. Alcohol is the predominant cause of CP in the western world and is particularly prevalent in South Africa, especially in the indigent patient. CP ranks high among intractable diseases of the gastrointestinal tract. The tendency for substance abuse in the alcohol-induced group poses major psychological and socioeconomic problems. OBJECTIVE: CP is a disease with significant clinical and pathological heterogeneity. Level 1 evidence to support definitive guidelines for diagnosis, medical management and interventional therapy is lacking. Despite this paucity of robust scientific evidence, it is important to provide some assistance based on the best available evidence as to the current standard of care for CP in the South African context; this will aid all involved in the management of the disease, and includes clinicians, health care managers and funders. Scope. The guidelines were developed as recommendations addressing the diagnosis, medical management and interventions, both endoscopic and surgical, for the management of a very complex and heterogeneous disease of the pancreas. The recommendations are particularly relevant in the South African context where the predominant patho-aetiological agents are alcohol-associated with smoking. RECOMMENDATIONS: The guidelines provide clear recommendations regarding the diagnostic modalities available, both imaging (which includes MRI and endoscopic ultrasound (EUS)) and pancreatic function tests. The section on medical management makes recommendations on the use of analgesics, enzyme replacement and other therapeutic options in the non-interventional management of the majority of patients with CP. The section on interventional procedures identifies the indications and options available for the interventional management of both uncomplicated and complicated CP. The role of endoscopic and surgical modalities is defined, but it is in this context especially that the best available evidence, combined with the experience of the group, influenced the recommendations put forward. Owing to the lack of evidence and the complexity of the disease, it is recommended that, where possible, CP is managed in the context of a multidisciplinary team. Validation. The guidelines are based on best practice principles determined by the available evidence and the opinions of the group, which comprised 7 medical and surgical gastroenterologists with significant experience in dealing with patients with chronic pancreatitis in the South African context. The group convened between May 2009 and August 2010 under the auspices of the Hepato-Pancreatico-Biliary Association of South Africa (HPBASA) and the South African Gastroenterology Society (SAGES), and the guidelines are the result of broad consensus within this group. The draft was presented to other experts in this field of endeavour to ensure broader participation and consensus. Plans for guideline revision. HPBASA and SAGES will publish a revised modification of the recommendations when new levels 1 and 2 evidence data are published

Health Communication and Psychological Distress: Exploring the Language of Self-harm

This study explores adolescents’ accounts of self-harm with a view to elucidate the implications for health care practitioners seeking to administer care to teenagers in English. Drawing on a corpus of 1.6 million words from messages posted on a UK-hosted adolescent health Web site, analysis began by identifying a range of keywords relating to self-harm. The subsequent contextual examination of these keywords afforded a close description of the contributors’ experiences of self-harm and the factors that resulted in their self-injurious behaviours. A recurring theme was that of the habitual nature of self-harm, with the act being represented as a form of addiction over which they had little control. Self-harmers construct the phenomenon as particularly powerful, and the act is formulated as the only effective means of relief from emotional turmoil. If we are to increase parents and health professionals’ ability to respond to self-injury in the medium of English, close linguistic attention to individuals’ accounts of self-harm is valuable. Online health resources are also valuable means of eliciting concerns from distressed adolescents who are often reluctant to seek support from professionals face-to-face