Anand R. Gupte; Chris E. Forsmark

Disclosures

Curr Opin Gastroenterol. 2014;30(5):500-505. 

In This Article

Abstract and Introduction

Abstract

Purpose of review We review selected important clinical observations in chronic pancreatitis reported in 2013.

Recent findings Early diagnosis of chronic pancreatitis remains difficult, although newer techniques utilizing endoscopic ultrasonography-elastography and MRI hold promise. Patients with chronic pancreatitis are at risk of nutritional deficiencies. Osteoporosis, osteopenia, and bone fracture are particularly common in these patients, and require active intervention and treatment. Diabetes caused by chronic pancreatitis, type 3c diabetes, has specific characteristics and requires careful management. Antioxidants and neuromodulators may decrease pain in some patients with chronic pancreatitis. Endoscopic treatment is effective and can be utilized in patients with painful chronic pancreatitis, although randomized trials demonstrate that surgical therapy is somewhat more durable and effective. Although surgery has typically been a last resort, some advocate early surgical intervention but the optimal time remains unknown.

Summary Early diagnosis of pancreatitis may be improved by newer techniques associated with endoscopic ultrasonography imaging. Treatment of nutritional deficiencies and diabetes is an important aspect of treating chronic pancreatitis. Pain relief with adjunct means of pain modulation should be tried before starting narcotics for pain control. Endoscopic therapy is appropriate for treating chronic pancreatitis and its local complications and surgical intervention can be considered early in carefully selected individuals.

Introduction

Chronic pancreatitis is a progressive fibro-inflammatory syndrome caused by a variety of etiological factors. The condition is associated with numerous genetic mutations and polymorphisms that predispose to disease, with varied environmental disease triggers, which are together necessary for disease expression. Histologically, it is characterized by mononuclear cell infiltration and the activation of pancreatic stellate cells with subsequent fibrosis and acinar and islet cell loss. The management of this condition is challenging, and most patients remain symptomatic and suffer from complications despite medical, endoscopic, and surgical therapy. Accurate diagnosis of chronic pancreatitis in the early stages when therapy might be most effective remains difficult. In this review, we focus on recent publications that address issues including early and accurate diagnosis, the role of genetics and environmental toxins, natural history of disease progression, mechanisms of pain, nutritional and metabolic issues associated with chronic pancreatitis, and recent developments in the management of the major features of exocrine insufficiency, endocrine insufficiency, and abdominal pain.

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