Chronic pancreatitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 21 Aug 2025

Last updated: 27 Aug 2025

Chronic pancreatitis is most commonly associated with chronic alcohol ingestion (>75%).

Hallmark features are epigastric abdominal pain radiating to the back, steatorrhea, malnutrition, and diabetes mellitus.

Diagnosis is based on clinical findings and imaging.

Underlying causes and precipitating factors should be treated. There is no definitive therapy; treatment is otherwise aimed at symptoms and complications.

Common complications include opioid addiction, pancreatic pseudocysts, pancreatic calcification, diabetes mellitus, and malabsorption.

Definición

Pancreatitis is a clinical diagnosis defined by pancreatic inflammation. Although not always clinically distinguishable, pancreatitis can be defined as acute or chronic. Acute pancreatitis is a self-limited and reversible pancreatic injury associated with mid-epigastric abdominal pain and elevated serum pancreatic enzymes, whereas chronic pancreatitis is characterized by recurrent or persistent abdominal pain and progressive injury to the pancreas and surrounding structures, resulting in scarring and loss of function. In those with recurrent attacks of pancreatitis, identifying the cause and type of pancreatitis involves distinguishing between four entities:[1]

1. Recurrent acute pancreatitis: there is an identifiable cause of acute pancreatitis that does not lead to chronic pancreatitis (e.g., gallstones, drugs, and hypercalcemia).

2. Idiopathic pancreatitis: exhaustive evaluation identifies no cause. Most commonly this represents chronic relapsing pancreatitis or definite chronic pancreatitis.

3. Chronic relapsing pancreatitis: patients have relapsing pain not recognized clinically as chronic pancreatitis (no hallmark features) but have pathologic changes in tissue specimens.

4. Established chronic pancreatitis: hallmark features of chronic pancreatitis are present, including reduced pancreatic exocrine function, malabsorption, diabetes, and pancreatic calcifications.

Anamnesis y examen

Principales factores de diagnóstico

abdominal pain
steatorrhea
jaundice

Todos los datos

Otros factores de diagnóstico

weight loss and malnutrition
diabetes mellitus/glucose intolerance
nausea and vomiting
bloating and/or excessive flatulence
skin nodules
painful joints
low-trauma fracture
abdominal distension
shortness of breath

Todos los datos

Factores de riesgo

alcohol
smoking
family history
celiac disease
psoriasis
high-fat, high-protein diet
tropical geography

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

computed tomography (CT) or magnetic resonance imaging (MRI)
endoscopic ultrasonography (EUS)
secretin-enhanced magnetic resonance cholangiopancreatography (s-MRCP)

Todos los datos

Pruebas diagnósticas que deben considerarse

histological examination
genetic testing
indirect pancreatic function test (fecal elastase-1)
fecal fat
steatocrit
direct pancreatic function tests
IgG4 levels
therapeutic trial of corticosteroids

Todos los datos

Algoritmo de tratamiento

Agudo

acute intermittent episodic pain

En curso

persistent pain management

Colaboradores

Autores

Matthew J. DiMagno, MD

Professor of Internal Medicine

Division of Gastroenterology and Hepatology

University of Michigan School of Medicine

Ann Arbor

Divulgaciones

MJD sits on committees, advisory boards, and/or editorial boards for the National Pancreas Foundation Michigan Chapter, Faculty of 1000 Research, Pancreatology, the Pancreapedia, and Pancreas. MJD has been a speaker for AGA Invited Speaker Symposium and NPF and Michigan Medicine 7th Annual Patient and Family Centered Care for Pancreatic Diseases.

Erik-Jan Wamsteker, MD

Associate Professor of Internal Medicine

Division of Gastroenterology and Hepatology

University of Michigan School of Medicine

Ann Arbor

Divulgaciones

EJW declares that he has no competing interests.

Allen Lee, MD

Assistant Professor of Internal Medicine

Division of Gastroenterology and Hepatology

University of Vermont College of Medicine

Burlington

Divulgaciones

AL has consulted for GSK and Atmo Biosciences.

Revisores por pares

Christopher Forsmark, MD

Professor of Medicine

Chief

Division of Gastroenterology, Hepatology, and Nutrition

University of Florida

Gainesville

Divulgaciones

CF is an author of a number of references cited in this topic.

Jakob R. Izbicki, MD, FACS

Chairman, Surgeon in Chief

Department of General, Visceral and Thoracic Surgery

University Hospital Hamburg-Eppendorf

Hamburg

Germany

Divulgaciones

JRI declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Dominguez-Munoz JE, Drewes AM, Lindkvist B, et al. Recommendations from the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis. Pancreatology. 2018 Dec;18(8):847-54. Resumen

Whitcomb DC, Buchner AM, Forsmark CE. AGA Clinical practice update on the epidemiology, evaluation, and management of exocrine pancreatic insufficiency: expert review. Gastroenterology. 2023 Nov;165(5):1292-301.Texto completo Resumen

Gardner TB, Adler DG, Forsmark CE, et al. ACG clinical guideline: chronic pancreatitis. Am J Gastroenterol. 2020 Mar;115(3):322-39. Resumen

ASGE Standards of Practice Committee, Sheth SG, Machicado JD, et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis: summary and recommendations. Gastrointest Endosc. 2024 Oct;100(4):584-94.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Pancreatic cancer
- Pancreatitis, acute
- Biliary colic
Más Diferenciales
Guías de práctica clínica
- American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis
- Chronic pancreatitis
Más Guías de práctica clínica
Folletos para el paciente
Chronic pancreatitis
Pancreatic cancer
Más Folletos para el paciente
Videos
Venepuncture and phlebotomy: animated demonstration
Más vídeos
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad

Chronic pancreatitis

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

acute intermittent episodic pain

persistent pain management

Colaboradores

Autores

Matthew J. DiMagno, MD

Divulgaciones

Erik-Jan Wamsteker, MD

Divulgaciones

Allen Lee, MD

Divulgaciones

Revisores por pares

Christopher Forsmark, MD

Divulgaciones

Jakob R. Izbicki, MD, FACS

Divulgaciones

Peer reviewer acknowledgements

Disclosures

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Videos

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice