Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug;113(8):1108-1110.
doi: 10.1038/s41395-018-0066-z.

Managing chronic pancreatitis: the view from medical pancreatology

Dhiraj Yadav  1 , Adam Slivka
Affiliations

Managing chronic pancreatitis: the view from medical pancreatology

Dhiraj Yadav et al. Am J Gastroenterol. 2018 Aug.
No abstract available

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

Guarantor of the article: Dhiraj Yadav.

Specific author contributions: Drafting of the article: Dhiraj Yadav. Critical review, revisions and final approval of the article: Dhiraj Yadav, Adam Slivka.

Financial support: None.

Potential competing interest: None.

Figures

Fig. 1
Fig. 1
Approach to evaluation and management of pain in chronic pancreatitis. CECT: contrast-enhanced computed tomography, preferably pancreas protocol; MRI: magnetic resonance imaging; MRCP: magnetic resonance cholangiopancreatography; EUS: endoscopic ultrasound; Rx: treatment; ET: endoscopic therapy; CBD: common bile duct; PUD: peptic ulcer disease; PERT: pancreatic enzyme replacement therapy. 1Abstinence from alcohol and smoking is recommended in all patients, as applicable. Pain management includes analgesics (acetaminophen, non-steroidal anti-inflammatory agents, narcotics), adjunctive treatment (tricyclic antidepressants, gabapentinoids, SSRIs, SNRIs), and other strategies (e.g. cognitive behavioral therapy) depending on pain severity and temporal nature. In patients with constant/frequent symptoms we seek assistance with pain clinic, psychology and psychiatry. 2Refers to obstructive disease due to stones and/or strictures in the pancreatic duct. 3Indication for ET typically is presence of ductal stones and/or stricture in the head/body of the pancreas. ET is used as a “bridge to surgery” in specific situations, e.g. an inflammatory mass in the head of the pancreas, to allow for resolution of inflammation in the pancreas and peripancreatic area. 4Indications for surgery include failed ET, heavy stone burden, especially in the body/tail region, and an inflammatory mass in the head of the pancreas. 3,4In suitable candidates, a discussion of total pancreatectomy with islet autotransplantation (TPIAT) occurs prior to consideration of ET and surgery. 5In a suitable candidate, surgery in this situation would typically be a TPIAT. Options in Italics have questionable/unclear benefit
See this image and copyright information in PMC

References

    1. Wilcox CM, Yadav D, Ye T, et al. Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings. Clin Gastroenterol Hepatol. 2015;13:552–60. - PMC - PubMed
    1. Petrone MC, Arcidiacono PG, Perri F, et al. Chronic pancreatitis-like changes detected by endoscopic ultrasound in subjects without signs of pancreatic disease: do these indicate age-related changes, effects of xenobiotics, or early chronic pancreatitis? Pancreatology. 2010;10:597–602. - PubMed
    1. Mohapatra S, Majumder S, Smyrk TC, et al. Diabetes mellitus is associated with an exocrine pancreatopathy: conclusions from a review of literature. Pancreas. 2016;45:1104–10. - PMC - PubMed
    1. Ketwaroo G, Brown A, Young B, et al. Defining the accuracy of secretin pancreatic function testing in patients with suspected early chronic pancreatitis. Am J Gastroenterol. 2013;108:1360–6. - PMC - PubMed
    1. Yadav D, Hawes RH, Brand RE, et al. Alcohol consumption, cigarette smoking and the risk of recurrent acute and chronic pancreatitis. Arch Intern Med. 2009;169:1035–45. - PMC - PubMed

Publication types