| Theme |
New Criteria of Chronic Pancreatitis |
| Title |
Chronic Pancreatitis : Etiology, Clinical Features and Medical Management |
| Author |
Ken-Ichiro Fukumitsu |
Third Department of Internal Medicine. University of Occupational and Environmental Health. Japan, School of Medicine. |
| Author |
Makoto Otsuki |
Third Department of Internal Medicine. University of Occupational and Environmental Health. Japan, School of Medicine. |
| [ Summary ] |
Chronic pancreatitis (CP) is an inflammatory disease in which progressive and irreversible structural changes to the pancreas result in permanent impairment of both exocrine and endocrine functions. Patients with chronic pancreatitis may present with episodes of abdominal pain that are clinically and biochemically indistinguishable from acute pancreatitis. The pancreatic duct and its branches are often dilated and irregular, and intraductal protein plugs and calcifications may form. The pancreatic acini are eventually destroyed in CP and replaced by fibrosis. Alcoholism accounts for 54% of all cases of CP : the remainder are idiopathic (35%) , gallstones (8%) , and the others(5%). It may be convenient to classify CP into 1) painful CP with recurrent attacks or persistent pain with no impairment of both exocrine and endocrine pancreatic functions (compensatory stage), 2) signs and symptoms of pancreatic insufficiency and complications (decompensated stage), or 3) transitional stage presenting with either pain or insufficiency. The treatment of CP focuses on pain relief, correction of maldigestion and malabsorption, and the management of complications. Anticholinergic agents are useful for pain relief by reducing stimulation of the gland. Oral protease inhibitor and/or pancreatic enzyme supplements may reduce pain in certain patients. Trypsin is possibly beneficial for pain but patients with steatorrhea require lipase. Thus, the treatment for CP should be selected according to signs and symptoms. |