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Diagnosis and Management of Chronic Pancreatitis
1
What is chronic pancreatitis?
The classic description is a prodrome of smoldering abdominal pain and eventual pancreatic insufficiency. Histologically, chronic fibroinflammatory processes result in destruction of the functioning endocrine and exocrine pancreatic cells.
2
What is the most common cause?
Alcohol abuse is a common cause in the developed world, accounting for 34%–60% of cases. Because only 3%–10% of those with alcohol use disorder develop pancreatitis, genetic risk factors and smoking are garnering more attention for their role in chronic pancreatitis. Other known causes include posttraumatic strictures, pancreas divisum, autoimmune disorders, and metabolic disorders (hypertriglyceridemia and hypercalcemia). The overall incidence is estimated to be 2–200 per 100,000 people.
3
Is chronic pancreatitis the result of acute pancreatitis?
Acute and chronic pancreatitis are viewed as being opposite ends of the same disease spectrum. For example, alcohol may cause damage to acinar cells through reactive oxygen species, leading to pancreatic stasis. The stasis causes inflammation from release of pancreatic enzymes, which eventually leads to fibrosis and stricture. Severe fibrosis is a hallmark of end-stage chronic pancreatitis.
4
How is chronic pancreatitis diagnosed?
A step-wise, image-guided approach starts with computed tomography (CT) to rule out masses and look for calcifications or pseudocysts. Magnetic resonance (MR)/magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) better visualize the parenchyma and duct. Endoscopic retrograde cholangiopancreatography (ERCP) is less common because of higher procedure risks. Pancreatic function tests (PFTs) show promise but are not yet widely available.
5
What are the signs of pancreatic insufficiency?
Insulin-dependent diabetes mellitus (found in up to 30% of patients) and steatorrhea (in 25%) at diagnosis. The form of diabetes associated with chronic pancreatitis is termed IIIc ; it can be particularly difficult to manage because of the destruction of both the insulin and glucagon producing cells.
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