Chronic pancreatitis

Although chronic pancreatitis is commonly attributed to alcohol consumption, it is now clear that newly discovered genetic mutations and smoking are also important risk factors, and idiopathic chronic pancreatitis is much more common than appreciated. The diagnosis rests on cross-sectional imaging, or endoscopic ultrasound, but these tests might be non-diagnostic early in the clinical course. Avoiding further exposure to toxins like alcohol and tobacco can moderate the disease course and reduce the risk of secondary pancreatic cancer and other non-pancreatic complications. Abdominal pain remains difficult to manage, but a good patient-doctor relationship allows reasonable goals to be set. Malabsorption—exocrine insufficiency—can occur, and requires appropriate dosage of pancreatic enzyme replacement therapy (PERT) and monitoring for osteoporosis. Secondary diabetes—endocrine insufficiency—can occur and can be difficult to manage, requiring an understanding of the unique mechanisms of diabetes in patients with chronic pancreatitis. Effective collaboration between primary care doctors and specialists in pain management, diabetes, gastroenterology, surgery, and radiology is important and often essential in these complex patients.

In this article, we review the causes, consequences, and management of chronic pancreatitis and its complications. The available therapeutic options, with very few exceptions, are not supported by randomised trials or high quality evidence, but are instead supported by guidelines1 and expert opinion.