Conservative Management of Chronic Pancreatitis

  • Yang-Yang Qian
  • Zhuan Liao
  • Zhao-Shen Li


Chronic pancreatitis (CP) is a progressive inflammatory disease usually presenting as upper abdominal pain with/without radiation to the back. In later stage, it can lead to exocrine (steatorrhea, malnutrition) or endocrine insufficiency (diabetes mellitus). Abdominal pain is the prominent complaint. Since the cause of abdominal pain can be changeable, it is necessary to exclude complications before medical management of pain like malignancy, pseudocysts, inflammatory, bleeding, biliary or duodenal obstruction that may contribute to abdominal pain (Lohr et al., Dig Dis 31(1):43–50, 2013; Sharma et al., Trop Gastroenterol 35(4):205–11, 2014).

In this chapter, we will focus on pharmacological measures for symptom control, which consists of management of pain, exocrine and endocrine insufficiency. Nutrition and lifestyle modification are undoubtedly the first step (Majumder and Chari, Lancet 387(10031):1957–66, 2016).


  1. Ahmed Ali U, Jens S, Busch OR, et al. Antioxidants for pain in chronic pancreatitis. Cochrane Database Syst Rev. 2014;8:CD008945.Google Scholar
  2. Aloulou A, Schue M, Puccinelli D, et al. Yarrowia lipolytica lipase 2 is stable and highly active in test meals and increases fat absorption in an animal model of pancreatic exocrine insufficiency. Gastroenterology. 2015;149(7):1910–9.e5.Google Scholar
  3. Anderson MA, Akshintala V, Albers KM, et al. Mechanism, assessment and management of pain in chronic pancreatitis: recommendations of a multidisciplinary study group. Pancreatology. 2016;16(1):83–94.CrossRefPubMedGoogle Scholar
  4. Bai H, Chen X, Zhang L, et al. The effect of sulindac, a non-steroidal anti-inflammatory drug, attenuates inflammation and fibrosis in a mouse model of chronic pancreatitis. BMC Gastroenterol. 2012;12:115.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Berry AJ. Pancreatic enzyme replacement therapy during pancreatic insufficiency. Nutr Clin Pract. 2014;29(3):312–21.CrossRefPubMedGoogle Scholar
  6. Bouwense SA, Olesen SS, Drewes AM, et al. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients. J Pain Res. 2015;8:375–86.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Capurso G, Signoretti M, Archibugi L, et al. Systematic review and meta-analysis: small intestinal bacterial overgrowth in chronic pancreatitis. United European Gastroenterol J. 2016;4(5):697–705.CrossRefPubMedPubMedCentralGoogle Scholar
  8. D’Haese JG, Ceyhan GO, Demi IE, et al. Pancreatic enzyme replacement therapy in patients with exocrine pancreatic insufficiency due to chronic pancreatitis. Pancreas. 2014;43(6):834–41.CrossRefPubMedGoogle Scholar
  9. Duggan SN, Ni Chonchubhair HM, Lawal O, et al. Chronic pancreatitis: a diagnostic dilemma. World J Gastroenterol. 2016;22(7):2304–13.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Duggan SN, Ewald N, Kelleher L, et al. The nutritional management of type 3c (pancreatogenic) diabetes in chronic pancreatitis. Eur J Clin Nutr. 2017;71(1):3–8.CrossRefPubMedGoogle Scholar
  11. Gooshe M, Abdolghaffari AH, Nikfar S, et al. Antioxidant therapy in acute, chronic and post-endoscopic retrograde cholangiopancreatography pancreatitis: an updated systematic review and meta-analysis. World J Gastroenterol. 2015;21(30):9189–208.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Greer JB, Thrower E, Yadav D. Epidemiologic and mechanistic associations between smoking and pancreatitis. Curr Treat Options Gastroenterol. 2015;13(3):332–46.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Gullo L, Barbara L, Labo G. Effect of cessation of alcohol use on the course of pancreatic dysfunction in alcoholic pancreatitis. Gastroenterology. 1998;95(4):1063–8.CrossRefGoogle Scholar
  14. Gupte AR, Forsmark CE. Chronic pancreatitis. Curr Opin Gastroenterol. 2014;30(5):500–5.CrossRefPubMedGoogle Scholar
  15. Gurusamy KS, Pallari E, Hawkins N, et al. Management strategies for pancreatic pseudocysts. Cochrane Database Syst Rev. 2016a;4:CD011392.PubMedGoogle Scholar
  16. Gurusamy KS, Lusuku C, Davidson BR. Pregabalin for decreasing pancreatic pain in chronic pancreatitis. Cochrane Database Syst Rev. 2016b;2:CD011522.PubMedGoogle Scholar
  17. Han S, Kheder J, Bocelli L, et al. Smoking cessation in a chronic pancreatitis population. Pancreas. 2016;45(9):1303–8.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Hobbs PM, Johnson WG, Graham DY. Management of pain in chronic pancreatitis with emphasis on exogenous pancreatic enzymes. World J Gastrointest Pharmacol Ther. 2016;7(3):370–86.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Issa Y, Bruno MJ, Bakker OJ, et al. Treatment options for chronic pancreatitis. Nat Rev Gastroenterol Hepatol. 2014;11(9):556–64.CrossRefPubMedGoogle Scholar
  20. Ito T, Ishiguro H, Ohara H, et al. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. Jpn Soc Gastroenterol. 2015;51:85–92.CrossRefGoogle Scholar
  21. Lohr JM, Haas SL, Lindgren F, et al. Conservative treatment of chronic pancreatitis. Dig Dis. 2013;31(1):43–50.CrossRefPubMedGoogle Scholar
  22. Luaces-Regueira M, Iglesias-Garcia J, Lindkvist B, et al. Smoking as a risk factor for complications in chronic pancreatitis. Pancreas. 2014;43(2):275–80.CrossRefPubMedGoogle Scholar
  23. Majumder S, Chari ST. Chronic pancreatitis. Lancet. 2016;387(10031):1957–66.CrossRefPubMedGoogle Scholar
  24. Moran RA, James T, Pasricha PJ. Pancreatic pain. Curr Opin Gastroenterol. 2015;31(5):407–15.CrossRefPubMedGoogle Scholar
  25. Niemann T, Madsen LG, Larsen S, et al. Opioid treatment of painful chronic pancreatitis. Int J Pancreatol. 2000;27(3):235–40.CrossRefPubMedGoogle Scholar
  26. Olesen SS, Juel J, Graversen C, et al. Pharmacological pain management in chronic pancreatitis. World J Gastroenterol. 2013a;19(42):7292–301.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Olesen SS, Graversen C, Bouwense SA, et al. Quantitative sensory testing predicts pregabalin efficacy in painful chronic pancreatitis. PLoS One. 2013b;8(3):e57963.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Park WG. Clinical chronic pancreatitis. Curr Opin Gastroenterol. 2016; 32(5):1.Google Scholar
  29. Rustag T, Njei B. Antioxidant therapy for pain reduction in patients with chronic pancreatitis a systematic review and meta analysis. Pancreas. 2015;44(5):812–8.CrossRefGoogle Scholar
  30. Sharma V, Rana SS, Bhasin DK. Medical management of pain in chronic pancreatitis. Trop Gastroenterol. 2014;35(4):205–11.CrossRefPubMedGoogle Scholar
  31. Siepsiak M, Szalek E, Karbownik A, et al. Pharmacokinetics of paracetamol in patients with chronic pancreatitis. Pharmacol Rep. 2016;68(4):733–6.CrossRefPubMedGoogle Scholar
  32. Smith RC, Smith SF, Wilson J, et al. Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency. Pancreatology. 2016;16(2):164–80.CrossRefPubMedGoogle Scholar
  33. Staahl C, Dimcevski G, Andersen SD, Thorsgaard N, et al. Differential effect of opioids in patients with chronic pancreatitis: an experimental pain study. Scand J Gastroenterol. 2007;42(3):383–90.CrossRefPubMedGoogle Scholar
  34. Talamini G, Bassi C, Falconi M, et al. Smoking cessation at the clinical onset of chronic pancreatitis and risk of pancreatic calcifications. Pancreas. 2007;35:320–6.CrossRefPubMedGoogle Scholar
  35. Talukdar R, Reddy DN. Pain in chronic pancreatitis: managing beyond the pancreatic duct. World J Gastroenterol. 2013;19(38):6319–28.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Talukdar R, Lakhtakia S, Nageshwar Reddy D, Rao GV, et al. Ameliorating effect of antioxidants and pregabalin combination in pain recurrence after ductal clearance in chronic pancreatitis: results of a randomized, double blind, placebo-controlled trial. J Gastroenterol Hepatol. 2016;31(9):1654–62.CrossRefPubMedGoogle Scholar
  37. Trang T, Chan J, Graham DY. Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency in the 21(st) century. World J Gastroenterol. 2014;20(33):11467–85.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Yadav D. Recent advances in the epidemiology of alcoholic pancreatitis. Curr Gastroenterol Rep. 2011;13(2):157–65.CrossRefPubMedGoogle Scholar
  39. Yadav D, Timmons L, Benson JT, et al. Incidence, prevalence, and survival of chronic pancreatitis: a population-based study. Am J Gastroenterol. 2011;106(12):2192–9.CrossRefPubMedGoogle Scholar
  40. Yaghoobi M, McNabb-Baltar J, Bijarchi R, et al. Pancreatic enzyme supplements are not effective for relieving abdominal pain in patients with chronic pancreatitis: meta-analysis and systematic review of randomized controlled trials. Can J Gastroenterol Hepatol. 2016;2016:8541839.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Zhou D, Wang W, Cheng X, et al. Antioxidant therapy for patients with chronic pancreatitis: a systematic review and meta-analysis. Clin Nutr. 2015;34(4):627–34.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. and Shanghai Scientific and Technical Publishers 2017

Authors and Affiliations

  1. 1.Department of GastroenterologyChanghai Hospital, The Second Military Medical UniversityShanghaiChina
  2. 2.Shanghai Institute of Pancreatic DiseasesShanghaiChina

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