慢性膵炎疑診例の病態仮説と治療戦略 : 現象学的・システム論的観点から

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Some patients complain of continuous or reccurent abdominal pain associated with high serum levels of pancreatic enzymes but without definite signs of chronic pancreatitis on various examinations including ERCP. CT and US. This condition has been called clinically suggested chronic pancreatitis (CSCP) . In this report, we propose a new pathophysiologic hypothesis and a strategy for the treatment of CSCP based on the viewpoint of system theory and phenomenology. A psychosomatic vicious cycle consisting of the following three processes is often observed in CSCP : 1) A depressive mood and anxiety induce hypersecretion of the pancreatic juice. 2) An elevation of the intraductal pressure resulting from the pancreatic hypersecretion causes abdominal pain and increases in the serum levels of pancreatic enzymes. 3) Exacerbation of the symptoms and the information of the abnormal examination results aggravate the depressive mood and anxiety of the patient. This vicious cycle is considered to exacerbate and prolong the disease in the presence of the constitutional factor of hyperreactivity of the pancreatic exocrine function. On the basis of this pathophysiologic hypothesis, we formulated the following therapeutic strategy from a viewpoint of system theory, focusing particularly on the physician-patient relationship. ( I ) Sufficient medical interview and physical examination ; ( 2 ) examinations needed to exclude malignancies ; ( 3 ) proper explanation of the disease ; ( 4 ) setting control of symptom as the goal of the treatment ; and ( 5 ) administration of anti-depressants, if necessary. In this report, the clinical courses of two cases of CSCP, a 39-year-old female and a 32-yearold male, treated according to this strategy are described phenomenologically, and the validity of the hypothesis and the therapeutic strategy is evaluated.
日本心身医学会の論文
1994-08-01

慢性膵炎疑診例の病態仮説と治療戦略 : 現象学的・システム論的観点から

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