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Chronic pancreatitis

Last reviewed: 10 Apr 2025
Last updated: 06 Feb 2024

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
  • steatorrhea
  • jaundice
Full details

Other diagnostic factors

  • 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
Full details

Risk factors

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

Diagnostic tests

1st tests to order

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

Tests to consider

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

Treatment algorithm

ACUTE

acute intermittent episodic pain

ONGOING

persistent pain management

Contributors

Authors

Matthew J. DiMagno, MD

Professor of Internal Medicine

Division of Gastroenterology and Hepatology

University of Michigan School of Medicine

Ann Arbor

MI

Disclosures

MJD has received grant support from National Institutes of Health. MJD has received honoraria and/or royalties from Oakstone Publishing and William M. Steinberg Board Review in Gastroenterology and Best Practices Course for publications and presentations related to pancreatic disorders. He has consulted for AbbVie, Chiesi, Nestlé, and Vivus. MJD sits on committees, advisory boards, and/or editorial boards for the AGA Institute, National Pancreas Foundation Michigan Chapter, Faculty of 1000 Research, Pancreatology, the Pancreapedia, and Pancreas.

Erik-Jan Wamsteker, MD

Associate Professor of Internal Medicine

Division of Gastroenterology and Hepatology

University of Michigan School of Medicine

Ann Arbor

MI

Disclosures

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

VT

Disclosures

AL has received grant funding from the National Institutes of Health.

Peer reviewers

Christopher Forsmark, MD

Professor of Medicine

Chief

Division of Gastroenterology, Hepatology, and Nutrition

University of Florida

Gainesville

FL

Disclosures

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

Disclosures

JRI declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Sherman S, Freeman ML, Tarnasky PR, et al. Administration of secretin (RG1068) increases the sensitivity of detection of duct abnormalities by magnetic resonance cholangiopancreatography in patients with pancreatitis. Gastroenterology. 2014;147:646-54.e2.Full text  Abstract

Gurusamy KS, Lusuku C, Davidson BR. Pregabalin for decreasing pancreatic pain in chronic pancreatitis. Cochrane Database Syst Rev. 2016;(2):CD011522.Full text  Abstract

Ahmed Ali U, Jens S, Busch OR, et al. Antioxidants for pain in chronic pancreatitis. Cochrane Database Syst Rev. 2014 Aug 21;(8):CD008945.Full text  Abstract

Ahmed Ali U, Pahlplatz JM, Nealon WH, et al. Endoscopic or surgical intervention for painful obstructive chronic pancreatitis. Cochrane Database Syst Rev. 2015 Mar 19;(3):CD007884.Full text  Abstract

Gurusamy KS, Lusuku C, Halkias C, et al. Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis. Cochrane Database Syst Rev. 2016 Feb 3;(2):CD011521.Full text  Abstract

Bachmann K, Tomkoetter L, Erbes J, et al. Beger and Frey procedures for treatment of chronic pancreatitis: comparison of outcomes at 16-year follow-up. J Am Coll Surg. 2014 Aug;219(2):208-16. Abstract

Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med. 2007;356:676-84. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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