Chronic pancreatitis: review and update of etiology, risk factors, and management

Abstract

Chronic pancreatitis is a syndrome involving inflammation, fibrosis, and loss of acinar and islet cells which can manifest in unrelenting abdominal pain, malnutrition, and exocrine and endocrine insufficiency. The Toxic-Metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and Severe Acute Pancreatitis, Obstructive (TIGAR-O) classification system categorizes known causes and factors that contribute to chronic pancreatitis. Although determining disease etiology provides a framework for focused and specific treatments, chronic pancreatitis remains a challenging condition to treat owing to the often refractory, centrally mediated pain and the lack of consensus regarding when endoscopic therapy and surgery are indicated. Further complications incurred include both exocrine and endocrine pancreatic insufficiency, pseudocyst formation, bile duct obstruction, and pancreatic cancer. Medical treatment of chronic pancreatitis involves controlling pain, addressing malnutrition via the treatment of vitamin and mineral deficiencies and recognizing the risk of osteoporosis, and administering appropriate pancreatic enzyme supplementation and diabetic agents. Cornerstones in treatment include the recognition of pancreatic exocrine insufficiency and administration of pancreatic enzyme replacement therapy, support to cease smoking and alcohol consumption, consultation with a dietitian, and a systematic follow-up to assure optimal treatment effect.

Keywords: Chronic; Pancreatitis; fibrosis.

Figure 1.. TIGAR-O risk factor classification system.

AP, acute pancreatitis; CFTR, cystic fibrosis transmembrane conductance regulator; CP, chronic pancreatitis; IBD, inflammatory bowel disease; PBC, primary biliary cirrhosis; SAPE, sentinel acute pancreatitis event; SPINK1, serine protease inhibitor kazal-type 1; TIGAR-O, Toxic-Metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and Severe Acute Pancreatitis, Obstructive. Adapted from .

Figure 2.. Endoscopic ultrasound images characterizing features of chronic pancreatitis.

(a) Anechoic tubular structure with multiple hyperechoic structures with shadowing. Depicts a dilated main pancreatic duct with multiple calcified stones. (b) Anechoic tubular structure depicting dilated, irregular main pancreatic duct. (c) Diffuse echogenicity with hyperechoic foci with stranding. Depicts pancreatic lobularity with calcifications.