By Beth Israel Deaconess Medical Center Staff
What began as a chance meeting between Steven D. Freedman, MD, PhD, and Peter Durie, MD, FRCP, at a 1991 medical conference has led to more than two decades of groundbreaking research and potential new therapies for children and adults living with the debilitating symptoms of chronic pancreatitis.
Durie is a world leader in the gastrointestinal aspects of cystic fibrosis at The Hospital for Sick Children in Toronto. Freedman, director of the Pancreas Center at the Digestive Disease Center and chief of the translational research division at Beth Israel Deaconess Medical Center (BIDMC), is recognized across the globe for his pioneering pancreatitis research and positive patient outcomes. Their discussion about the similarities between cystic fibrosis and pancreatitis – specifically that both involve too-thick secretions that negatively affect organ function – inspired a clinical trial and the discovery that up to 60 percent of patients who had chronic pancreatitis had a mutation of or were carriers of the cystic fibrosis gene.
With new knowledge in hand, Freedman went back to his basic science work and made another landmark discovery. He explains, “While working on a mouse model, we found that, at least in part, if you have mutations in the cystic fibrosis gene, it affects certain fats called fatty acids. Correcting fatty acid imbalances cured the mice of the disease.” Research in this area is ongoing, including clinical trials investigating high-dose docosahexaenoic acid (DHA) as a treatment for cystic fibrosis-related conditions, including pancreatitis.
“Knowing that gene mutations predispose individuals to pancreatitis opened up a whole new avenue of research,” says Freedman. “It gave us great potential to develop exciting new therapies.”
Dispelling Myths and Improving Diagnostic Tools
Pancreatitis is inflammation of the pancreas that causes digestive enzymes to attack and damage surrounding tissues. With chronic pancreatitis, the inflammation does not heal, worsens over time, and can lead to permanent damage, severe pain, and pancreatic insufficiency. Its primary symptom is upper-abdominal pain that can get worse after eating. Pancreatitis is the most common reason for gastrointestinal-related hospitalization, and strikes young and old alike.
“Contrary to popular belief, only a small subset of pancreatitis cases are related to heavy alcohol use. “It is not just a disease of alcoholics,” says Freedman. “In many patients, including young children, the cause of the inflammation is unexplained.”
Chronic pancreatitis can be difficult to diagnose because CT scans, MRI scans, ultrasounds, and standard blood tests often show normal results for three to four years, despite the presence of the disease. The BIDMC Pancreas Center is one of only a few centers in the world that performs specially modified endoscopic secretin pancreatic function testing, a highly sensitive test that can diagnose pancreatitis up to three years before changes can be seen on radiologic imaging tests. “This test actually looks at how the pancreas is functioning, as opposed to imaging tests that show only structural abnormalities,” Freedman says.
Clinical Trials Give Access to Novel Treatments
Conventional treatment for pancreatitis includes narcotic medications for pain, parenteral nutrition (intravenous feeding) to bypass the digestive process, and surgery when indicated. Freedman, his team, and a multidisciplinary group of specialists at BIDMC are working to expand the tools available in their arsenal of chronic pancreatitis diagnostic and treatment tools.
“Because the main symptom of chronic pancreatitis is chronic pain, finding ways to remove or minimize pain is a major goal,” says Freedman. In another revolutionary study, Freedman teamed up with Alvaro Pascual-Leone MD, PhD, chief of the division of cognitive neurology and director of the Berenson-Allen Center for Noninvasive Brain Stimulation at BIDMC, focusing in on the site in the brain that signals pancreas pain.
Clinical trials in which transcranial magnetic stimulation (TMS) — a noninvasive magnetic beam — was applied over that area of the scalp resulted in 70 percent of patients achieving significant reduction in their pain. “The results indicate that we may have a way to diminish the pain noninvasively and without the use of narcotics,” Freedman notes. The Pancreas Center is currently enrolling patients in another clinical trial in collaboration with Spaulding Rehabilitation Hospital using transcranial direct current stimulation (tDCS) — a simpler form of TMS — combined with meditation.
Every Great Team Needs a Great Quarterback
“We act as the quarterback for every patient, planning and coordinating their care with them and making sure they have access to every possible option to enhance their quality of life,” says Freedman. Patients new to the Pancreas Center are seen within one week, and initial office visits generally last up to 90 minutes. In addition to documenting the medical history and physical exam findings, Freedman maps out a patient’s presenting problems, details all of the possible causes, discusses how tests or treatments ordered may change the management plan, relays what he and his multidisciplinary team will do to make them better, and stays in touch every one to two weeks until symptoms have improved.
“Not a lot of other centers do this,” says Freedman. “Your health is a priority, but it’s hard to navigate the medical field, especially when multiple specialists are involved. Whether it is you or a loved one who is ill, whether it is a chronic illness or not, you need to know that everything that needs to be done is being done. I am happy to be a resource.”
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted April 2016