Altered brain morphology in chronic pancreatitis patients and its association with pain and other disease characteristics

OBJECTIVE: Abnormal pain processing in the central nervous system is a hallmark of chronic pancreatitis (CP). We characterized brain structure in CP patients and identified disease characteristics that impact the brain structure in CP patients.

PATIENTS AND METHODS: Thirty-three CP patients and 23 matched healthy controls underwent brain MRI. Total and regional gray matter volume (GMV) and cortical thickness analyses were carried out. Multivariate linear regression models were used to determine the independent predictors of total GMV.

RESULTS: CP patients had 31.9±9.3 ml (mean±SE) (5.1%) reduced total GMV compared with the healthy controls (587.1±5.8 vs. 619.0±7.0 cm, P<0.001). Alcoholic etiology was associated independently with a decreased total GMV (P<0.001), whereas no association was observed for pain or other disease characteristics (all P>0.05). Similarly, regional GMV loss and cortical thinning were observed for several cortical areas in patients with alcoholic etiology compared with their nonalcoholic counterparts (P<0.05). These regional differences were particularly evident for pain-related cortical areas; however, no significant differences in regional GMV or cortical thickness were observed between patients with and without pain (all P>0.05).

CONCLUSION: Patients with CP have GMV loss that is associated with alcoholic disease etiology. No associations were detected between pain and GMV loss, likely because the potential effect of long-lasting pain on brain structure is masked by the effects of previous alcohol use. The findings imply that alcoholic etiology is the most prominent contributing factor for structural brain alterations in CP patients.