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Review
. 2012 Sep;28(5):523-31.
doi: 10.1097/MOG.0b013e3283567dea.

Chronic pancreatitis

Matthew J DiMagno  1 , Eugene P DiMagno
Affiliations
Review

Chronic pancreatitis

Matthew J DiMagno et al. Curr Opin Gastroenterol. 2012 Sep.

Abstract

Purpose of review: We review important new clinical observations in chronic pancreatitis reported in 2011.

Recent findings: Smoking increases the risk of nongallstone acute pancreatitis and the progression of acute pancreatitis to chronic pancreatitis. Binge drinking during Oktoberfest did not associate with increased hospital admissions for acute pancreatitis. The unfolded protein response is an adaptive mechanism to maintain pancreatic health in response to noxious stimuli such as alcohol. Onset of diabetes mellitus in chronic pancreatitis is likely due to progressive disease rather than individual variables. Insufficient pancreatic enzyme dosing is common for treatment of pancreatic steatorrhea; 90 000 United States Pharmacopeia units of lipase should be given with meals. Surgical drainage provides sustained, superior pain relief compared with endoscopic treatment in patients advanced chronic pancreatitis with a dilated main duct ± pancreatic stones. The central acting gabapentoid pregabalin affords a modest 12% pain reduction in patients with chronic pancreatitis but approximately 30% of patients have significant side effects.

Summary: Patients with nongallstone-related acute pancreatitis or chronic pancreatitis of any cause should cease smoking. Results of this year's investigations further elucidated the pancreatic pathobiology due to alcohol, onset of diabetes mellitus in chronic pancreatitis, and the mechanisms and treatment of neuropathic pain in chronic pancreatitis.

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Conflict of interest statement

Conflicts of interest

MJD receives research support from the National Institutes of Health (K08 DK073298, R21 AA017271), the Michigan Institute for Clinical and Health Research (MICHR) and the University of Michigan Office of Vice President of Research (OVPR). MJD received the drug Pioglitazone from Takeda Pharmaceuticals North America for use in an NIH sponsored clinical research trial (2008). MJD received honoraria from Lippincott Williams & Wilkins (Philadelphia, PA, USA) for articles published in Current Opinion in Gastroenterology, Springer (New York, NY, USA) for an article published in Current Gastroenterology Reports and the British Medical Journal for articles published in BMJ Point of Care). MJD also received a consulting fee from MD Evidence (Atlantic City, NJ, USA) for co-authoring a systematic review published in 2009 entitled, “Systematic review: Pancreatic enzyme treatment for malabsorption associated with chronic pancreatitis”. EPD has no financial or other relationship(s) to disclose.

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References

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