Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
- steatorrhea
- jaundice
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
Risk factors
- alcohol
- smoking
- family history
- celiac disease
- psoriasis
- high-fat, high-protein diet
- tropical geography
Diagnostic tests
1st tests to order
- computed tomography (CT) or magnetic resonance imaging (MRI)
- endoscopic ultrasonography (EUS)
- secretin-enhanced magnetic resonance cholangiopancreatography (s-MRCP)
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
Treatment algorithm
acute intermittent episodic pain
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
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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