Practical guide to the management of chronic pancreatitis

Abstract

Chronic pancreatitis (CP) is an irreversible fibroinflammatory disorder of the pancreas. It presents with relapsing, remitting upper abdominal pain accompanied by features of malabsorption due to pancreatic exocrine insufficiency and endocrine deficiency with the development of diabetes mellitus. The associated increased hospitalisation and high economic burden are related to CP often presenting at advanced stage with irreversible consequences. Diagnosing CP at an early stage is still challenging and therefore CP is believed to be under-reported. Our understanding of this disease has evolved over the last few years with attempts to redesign the definition of CP. Better recognition of the risk factors and conditions associated with CP can lead to an earlier diagnosis and coupled with a multidisciplinary approach to treatment, ultimately reduce complications. This article reviews the epidemiology, risk factors, diagnosis and management of CP.

Keywords: chronic pancreatitis; exocrine pancreatic function; pancreatic enzymes; pancreatitis.

Figure 1

Complications of CP illustrated with CT: (A) Recurrent pancreatic inflammation results in atrophy with secondary PEI and diabetes (B) Dilated pancreatic duct containing a large (white) stone at the distal end resulting in pain and PEI. (C) A pseudocyst causing gastric outlet obstruction has developed with a nasogastic tube in situ. (D) Calcification in the pancreas parenchyma, recurrent inflammation adjacent to coeliac axis results in pain. In this patient, a gastroenterostomy feeding tube has also in situ for nutritional support. CP, chronic pancreatitis; PEI, pancreatic exocrine insufficiency.