Chronic Pancreatitis: Managing a Difficult Disease

Abstract

Chronic pancreatitis is characterized by progressive, irreversible morphologic and functional changes that are most commonly attributed to environmental insults, particularly when there is a genetic or anatomic predisposition. Heavy alcohol use and cigarette smoking are the most common environmental risk factors, but both may be absent. Antecedent episodes of acute pancreatitis occur in about half of patients. Abdominal pain is the most common symptom and requires a tailored approach depending on the anatomic changes in the pancreas. Other clinical manifestations include diabetes mellitus, exocrine pancreatic insufficiency, metabolic bone disease, pancreatic cancer, and anatomic complications. Current disease management is centered on risk factor reduction and screening for and treating disease complications. There are no current therapies to delay or retard disease progression, but there are ongoing efforts to more fully understand the natural history of chronic pancreatitis and underlying mechanisms of disease. These studies are expected to provide insights that will transform our approach to disease management and provide increased hope to patients.

Figure 1.

CT imaging features of chronic pancreatitis (from different patients). Panel A: Bulky calcifications in the pancreatic parenchyma and main pancreatic duct. Panel B: Medium-sized pancreatic pseudocyst causing mild pancreatic duct dilation and associated with small pancreatic calcifications and parenchymal atrophy. Panel C: Small pancreatic calcifications, including an intraductal stone causing pancreatic duct obstruction. Panel D: Biliary obstruction secondary to chronic pancreatitis manifest by intra- and extra-hepatic biliary dilation.

Figure 2.

MR imaging features of chronic pancreatitis (in the same patient). Panel A. Decreased T1 signal of the gland and parenchymal atrophy. Panel B. Dilation of the main pancreatic duct and multiple branch ducts on a T2 MRCP image.