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Review
. 2016 Feb 21;22(7):2304-13.
doi: 10.3748/wjg.v22.i7.2304.

Chronic pancreatitis: A diagnostic dilemma

Sinead N Duggan  1 , Hazel M Ní Chonchubhair  1 , Oladapo Lawal  1 , Donal B O'Connor  1 , Kevin C Conlon  1
Affiliations
Review

Chronic pancreatitis: A diagnostic dilemma

Sinead N Duggan et al. World J Gastroenterol. .

Abstract

Typical clinical symptoms of chronic pancreatitis are vague and non-specific and therefore diagnostic tests are required, none of which provide absolute diagnostic certainly, especially in the early stages of disease. Recently-published guidelines bring much needed structure to the diagnostic work-up of patients with suspected chronic pancreatitis. In addition, novel diagnostic modalities bring promise for the future. The assessment and diagnosis of pancreatic exocrine insufficiency remains challenging and this review contests the accepted perspective that steatorrhea only occurs with > 90% destruction of the gland.

Keywords: Diagnosis; Exocrine pancreatic insufficiency; Malabsorption; Pancreatic enzyme replacement therapy; Pancreatitis, chronic.

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Figures

Figure 1
Figure 1
Computed tomography demonstrating enlarged head of pancreas with coarse calcification and a dilated main pancreatic duct (A), magnetic resonance cholangiopancreatography showing a tortuous, dilated pancreatic duct (B), inflammatory stricture of the distal common bile duct (C), endoscopic retrograde cholangiopancreatography showing a stent placed in a dilated pancreatic duct (D).
Figure 2
Figure 2
Step-wise algorithm approach to diagnosis of chronic pancreatitis. Step 1: Survey (data review, risk factors, CT-imaging); Step 2: Tomography (pancreas protocol CT scan, MRI/secretin-enhanced magnetic resonance cholangiopancreatography); Step 3: Endocopy [EUS (standard criteria)]; Step 4: Pancreas functioning (Dreiling, ePFT); Step 5: ERCP (with intent for therapeutic intervention). From Conwell et al[2]. CT: Computed tomography; MRI: Magnetic resonance imaging; EUS: Endoscopic ultrasound; ERCP: Endoscopic retrograde cholangiopancreatography.
Figure 3
Figure 3
Relation of lipase outputs per 24 h to fecal fat excretion in healthy subjects and patients with chronic pancreatitis. Values above the horizontal dashed line denote steatorrhea (> 7 g per 24 h). The shaded area represents lipase outputs less than 10 percent of normal. From DiMagno et al[34]. Copyright © 2015 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.
Figure 4
Figure 4
Relation of lipase output to fecal fat excretion in 47 patients with exocrine insufficiency. Reprinted with permission from Lankisch et al[35]. Copyright © 2015 Karger Publishers, Basel, Switzerland.
See this image and copyright information in PMC

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