Chronic pancreatitis: review and update of etiology, risk factors, and management

Abstract

Chronic pancreatitis is a syndrome involving inflammation, fibrosis, and loss of acinar and islet cells which can manifest in unrelenting abdominal pain, malnutrition, and exocrine and endocrine insufficiency. The Toxic-Metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and Severe Acute Pancreatitis, Obstructive (TIGAR-O) classification system categorizes known causes and factors that contribute to chronic pancreatitis. Although determining disease etiology provides a framework for focused and specific treatments, chronic pancreatitis remains a challenging condition to treat owing to the often refractory, centrally mediated pain and the lack of consensus regarding when endoscopic therapy and surgery are indicated. Further complications incurred include both exocrine and endocrine pancreatic insufficiency, pseudocyst formation, bile duct obstruction, and pancreatic cancer. Medical treatment of chronic pancreatitis involves controlling pain, addressing malnutrition via the treatment of vitamin and mineral deficiencies and recognizing the risk of osteoporosis, and administering appropriate pancreatic enzyme supplementation and diabetic agents. Cornerstones in treatment include the recognition of pancreatic exocrine insufficiency and administration of pancreatic enzyme replacement therapy, support to cease smoking and alcohol consumption, consultation with a dietitian, and a systematic follow-up to assure optimal treatment effect.

Suboptimal care for chronic pancreatitis patients revealed by moderate to low adherence to the United European Gastroenterology evidence‐based guidelines (HaPanEU): A Netherlands nationwide analysis

“…[8][9][10][11] Pain is reported in around 90% of the CP patients and about half of those patients will continue to have pain, despite therapy, adversely influencing their QoL. 12,13 Other factors that negatively influence QoL are a lower body weight, longer disease duration, pancreatic exocrineand endocrine-insufficiency, systemic inflammation, persistent smoking and unemployment. 7,11,14,15 Management of CP is difficult and involves many domains of health care.…”

The role of surgery in chronic pancreatitis

“…Pain remains the key symptom of clinical presentation and the primary focus of clinical management. It has been hypothesized that recurrent episodes of pain are due to progressive pancreatic fibrosis [9]. Delays in diagnosis from the onset of symptoms to establishment of diagnosis may range from 62 to 81 months.…”

Pancreatitis in rheumatoid arthritis and the role of systemic vasculitis of autoimmune origin in the pathogenesis of pancreatitis – A postmortem clinicopathologic study of 161 patients

“…2,14 The cause of chronic pancreatitis cannot be identified in about 25 -30% of patients. 7,8,10,11 Chang et al 1 concluded in their cohort study, that the patients with RA are at higher risk for acute pancreatitis compared to those without RA. 1 In our study the risk of LnP or A-SV was higher in elderly female RA patients at later onst of RA (55.4 years versus 50.15, and 60.57 years versus 48.33 resp.).…”

“…2,[6][7][8] The TIGAR-O classification system categorizes known causes and risk factors that may interact and produce acute, acute recurrent or chronic pancreatitis. 9,10 Acute, acute recurrent and chronic pancreatitis represent a disease continuum. 10 The progression of acute pancreatitis to a chronic one may be evident.…”

“…9,10 Acute, acute recurrent and chronic pancreatitis represent a disease continuum. 10 The progression of acute pancreatitis to a chronic one may be evident. 11,12 The initial and most characteristic feature of acute liponecrotic pancreatitis (aLnP) is acinar cell necrosis followed by a more or less pronounced inflammatory reaction, and later glandular atrophy and fibrosis.…”