Chronic pancreatitis

Phillip P. Toskes and Richard A. Schatz

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199204854
Published online November 2012 | e-ISBN: 9780199570973 | DOI:

Series: Oxford Textbooks

Chronic pancreatitis

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Chronic pancreatitis is most commonly due to chronic alcoholism in adults and cystic fibrosis in children, but there are many other causes/associations. Typical presentation is with (1) abdominal pain—but this is not always a feature and when present can vary from being mild to extremely severe; and/or (2) maldigestion—diarrhoea/steatorrhoea and weight loss.

Accurate diagnosis requires a combination of a hormone stimulation test (e.g. secretin–cholecystokinin stimulation of bicarbonate and enzyme secretion) and a structural test, e.g. endoscopic ultrasonography or endoscopic retrograde cholangiopancreatography ERCP). In routine clinical practice common strategy is to evaluate patients suspected of having chronic pancreatitis with a noninvasive test, e.g. faecal elastase (reduced), and initiate treatment if the result is abnormal, reserving invasive tests for cases where diagnostic doubt remains or clinical progress is unsatisfactory.

Management requires use of (1) potent enzyme formulations—protease for pain, lipase for steatorrhoea; given before meals and (if pain is a symptom) before bedtime, (2) acid suppressive therapy—H2 antagonist or proton pump inhibitor; (3) abstinence from alcohol; (4) diet that is moderate in fat (30%), high in protein (24%), and low in carbohydrate (40%); (5) pain control—if required, (a) non-narcotic analgesics are the pain-relieving medications of choice, and (b) lateral pancreaticojejunostomy (Peustow procedure) should be considered if there is dilatation of the main pancreatic duct.

Chapter.  5339 words.  Illustrated.

Subjects: Gastroenterology

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