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Review
. 2013 Sep;29(5):531-6.
doi: 10.1097/MOG.0b013e3283639370.

Chronic pancreatitis

Matthew J DiMagno  1 , Eugene P DiMagno
Affiliations
Review

Chronic pancreatitis

Matthew J DiMagno et al. Curr Opin Gastroenterol. 2013 Sep.

Abstract

Purpose of review: We review selected important clinical observations reported in 2012.

Recent findings: Celiac disease is a risk factor for pancreatitis. Patients with recurrent acute pancreatitis likely have chronic pancreatitis, do not benefit from pancreatic sphincterotomy, and may not benefit from biliary sphincterotomy. Analysis of endoscopic ultrasonography (EUS) images with an artificial neural network (ANN) program may improve chronic pancreatitis diagnosis compared with clinical interpretation of images. In a multicenter, randomized controlled trial of chronic pancreatitis patients, 90 000 USP U of pancreatin with meals decreased fat malabsorption compared with placebo. Detection of visceral pain in chronic pancreatitis predicts pain relief from various treatments, but nonvisceral pain due to altered central pain processing may respond to agents such as pregabalin. Predictors of surgical pain relief include onset of symptoms less than 3 years and preoperatively no opioid use and less than five endoscopic procedures. Total pancreatectomy for presumed painful chronic pancreatitis remains controversial.

Summary: Celiacs are at risk for pancreatitis. The diagnosis of chronic pancreatitis may be enhanced by ANN analysis of EUS imaging. Treatment of fat malabsorption requires 90,000 USP U of lipase with meals. Relief of pain from organ directed treatment of chronic pancreatitis may depend upon timing of interventions and whether pain is visceral or nonvisceral.

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Conflict of interest statement

Conflicts of interest

M.J.D. receives research support from the National Institutes of Health (R21 AA017271) and the Michigan Institute for Clinical and Health Research (MICHR). M.J.D. received honoraria from 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. E.P.D. has no financial or other relationship(s) to disclose.

M.J.D. and E.P.D. have no conflicts of interest.

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