Chronic pancreatitis

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

Hallmark features are epigastric abdominal pain radiating to the back, steatorrhoea, 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.

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-limiting and reversible pancreatic injury associated with mid-epigastric abdominal pain and elevated serum pancreatic enzymes, whereas chronic pancreatitis is characterised 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]DiMagno EP, DiMagno MJ. Chronic pancreatitis: landmark papers, management decisions, and future. Pancreas. 2016 May-Jun;45(5):641-50. http://www.ncbi.nlm.nih.gov/pubmed/27077713?tool=bestpractice.com

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

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 recognised clinically as chronic pancreatitis (no hallmark features) but have pathological 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.