Chronic pancreatitis

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Opinion statement

Management of chronic pancreatitis is a difficult endeavor for the clinician due to a variety of reasons. These include the variable presentation of symptoms such as chronic pain, recurrent pain, pain associated with malabsorption due to maldigestion, or even maldigestion alone in 15% of patients. It is paramount that the clinician and patient devise appropriate treatment based on prevailing symptoms, and anatomical/functional alterations in the pancreas. Concentrating on symptoms allows the best opportunity to improve the patient’s quality of life. Having an understanding of the patient’s anatomical and functional derangement will assist the clinician in targeting treatment particular to the individual. Awareness of complications associated with chronic pancreatitis is important to allow detection and treatment as they are encountered.

Treatment of chronic pancreatitis involves a stepwise approach. Treatment options that are the least invasive and are proven to work should be tried first, and if they are unsuccessful, appropriate alternative treatments can be employed. First-line therapy involves analgesics, non-narcotic and narcotic, in conjunction with pancreatic enzymes. For the pain-predominant cases, this includes nonenteric-coated enzyme supplements. For the individual with maldigestion as the predominant symptom, this includes entericcoated enzyme supplements. This initial trial should be continued for 3 to 6 months. If this fails to provide adequate improvement, then individualized treatment should involve surgical options and if appropriate in specific instances, endoscopic approaches.