Chronic pancreatitis

Descripción general 
Teoría 
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Última revisión: 9 Aug 2025

Última actualización: 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

Christopher Forsmark, MD

Professor of Medicine

Chief

Division of Gastroenterology, Hepatology, and Nutrition

University of Florida

Gainesville

Declarações

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

Declarações

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.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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. Resumo

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 Resumo

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

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 Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
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Diretrizes
- American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis
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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

Christopher Forsmark, MD

Declarações

Jakob R. Izbicki, MD, FACS

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Videos

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice