[Diagnosis and management of chronic pancreatitis]

Chronic calcifying pancreatitis is mainly due to chronic alcohol consumption. The first years of its evolution are marked by a painful disease and often weightloss as well as complications including acute pancreatitis, pseudocysts, compression of common bile duct, pleural effusion ascitis, and gastrointestinal bleedings. Between five and ten years evolution, pain is less frequent but risk for pseudocyst or jaundice still remains. Ten years after the onset of the disease pancreatic pain disappears while pancreas becomes calcified and fibrotic. Only diabetes and exocrine insufficiency are present at this stage. Medical treatment is mainly based on alcohol withdrawal, analgesics and restoration of normal nutritional status. Pain could be decreased but sometimes endoscopic, radiologic or surgical procedures are required. Insulin is often proposed for diabetes while exocrine insufficiency is substituted by gastro-resistant microgranules pancreatic extracts.