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Digestive Diseases and Sciences

, Volume 62, Issue 7, pp 1713–1720 | Cite as

Diagnosing Chronic Pancreatitis

  • Ahmad Anaizi
  • Phil A. Hart
  • Darwin L. Conwell
Review

Abstract

Diagnosing CP can range from routine in those with severe disease and obvious calcifications on CT imaging to elusive in those patients with early changes in CP. The workup of suspected CP should follow a progressively noninvasive to more invasive STEP-wise approach in a patient with a suspicious clinical presentation and risk factors that raise their pretest probability of disease. After a thorough history and physical examination, basic laboratories should be obtained such as lipase, amylase, metabolic panel, and indirect PFTs (fecal elastase-1, serum trypsin). Computed tomography remains the best initial imaging modality to obtain as it has good sensitivity for severe CP and may obviate the need for other diagnostic tests. When equivocal, an MRCP should be obtained for a more detailed evaluation of the both the pancreatic parenchyma and ducts. If the diagnosis remains in doubt, EUS should be performed with or without pancreas function testing. ERCP remains a last-line diagnostic test and seldom should be used outside of therapeutic purposes. Future advances should target optimizing current diagnostic tools to more accurately diagnose early CP, as it is in this population where the benefits of delaying progression of CP may have the most profound effect. Likely the best way at establishing a diagnosis in these patients is via pancreatic function testing in the setting of indeterminate EUS results. Biomarker studies of pancreas fluid may supplement diagnosis.

Keywords

Chronic pancreatitis Pancreatic function tests MRCP EUS Minimal change pancreatitis 

Abbreviations

CP

Chronic pancreatitis

CCK

Cholecystokinin

PDAC

Pancreatic ductal adenocarcinoma

PFT

Pancreatic function testing

MRCP

Magnetic resonance cholangiopancreatography

ERCP

Endoscopic retrograde cholangiopancreatogram

CT

Computed tomography

Notes

Acknowledgments

Research reported in this publication was supported by the National Cancer Institute and National Institute of Diabetes And Digestive and Kidney Diseases (NIDDK) under Award Number U01DK108327 (PH, DC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Conflicts of interest

Dr. Hart’s potential conflicts of interest include receiving honoraria for speaking from Abbvie, Inc, and consulting fees from KC Specialty Therapeutics, LLC.

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Section of Pancreatic Disorders, Division of Gastroenterology, Hepatology, and NutritionThe Ohio State University Wexner Medical CenterColumbusUSA

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