Chronic Pancreatitis: Managing a Difficult Disease

Abstract

Chronic pancreatitis (CP) is characterized by progressive, irreversible morphologic and functional changes that are most commonly attributed to environmental insults, particularly when there is a genetic or anatomic predisposition. Heavy alcohol use and cigarette smoking are the most common environmental risk factors, but both may be absent. Antecedent episodes of acute pancreatitis occur in about half of patients, so active interventions are needed to reduce the risk of disease progression. Abdominal pain is the most common symptom, and requires a tailored approach depending on the anatomic changes in the pancreas. Other clinical manifestations include diabetes mellitus, exocrine pancreatic insufficiency, metabolic bone disease, pancreatic cancer, and anatomic complications. Current disease management is centered on risk factor reduction, and screening for and treating disease complications. There are no current therapies to delay or retard disease progression, but there are ongoing efforts to more fully understand the natural history of CP and underlying mechanisms of disease. These studies are expected to provide insights that will transform our approach to disease management and provide further hope to patients.

Current Approaches in Chronic Pancreatitis

“…Although true prevalence is approximately < 50 per 100,000 adults, peaking in patients aged 46-55 years, the determination of its prevalence is difficult because of local standards and reporting bias. The incidence is predicted to be 4 to 5 new diagnoses per 100,000 yearly [1]. Data from Italian, Spanish, Chinese and Japanese surveys have the similar results as mentioned above [2].…”

“…Exocrine pancreatic insufficiency (EPI) is indicated by symptoms of steatorrhea (foul-smelling, oily stool), diarrhea, and weight loss. The gold standard for the diagnosis of EPI is a decreased coefficient of fat absorption (CFA) [1]. CFA of less than 93% (or >7 g of fat per 24 hours from a 72-hour fecal fat collection in a patient who is consuming 100 g of dietary fat each day during stool collection) defines steatorrhea or fat malabsorption [112].…”

“…While PDAC screening is not routinely recommended, it is advised to retain high clinical suspicion in those with unexplained symptoms, such as unexplained weight loss or changes in abdominal pain characteristics [1,71]. In all patients with chronic pancreatitis, newly diagnosed diabetes may be an early sign of pancreatic cancer and may prompt further research.…”

“…Unfortunately, the baseline morphological changes in the pancreas (especially the main pancreatic duct dilatation) in CP make it difficult to recognize a small neoplasm in cross-sectional imaging. In patients with multiple calcifications which may mask changes in the parenchyma, there is a chance of sampling error with EUS-guided fine needle aspiration [1].…”

Chaihu Guizhi Ganjiang Decoction Ameliorates Pancreatic Fibrosis via JNK/mTOR Signaling Pathway

“…Chronic pancreatitis (CP) is a progressive pathological change in the pancreas, characterized by glandular atrophy and fibrosis, which leads to endocrine and exocrine dysfunction ( Witt et al, 2007 ). To date, the clinical therapeutic intervention of CP is mainly symptomatic treatment including alleviation of pain, pancreatic enzyme supplementation, nutritional support therapy, and surgical therapy ( Hart and Conwell, 2020 ). However, the underlying pathogenesis of CP is still unclear, and there is lack of specific therapeutic drugs for pancreatic fibrosis.…”