[Reliability of the diagnosis of chronic pancreatitis]

Severe chronic pancreatitis can be easily diagnosed by means of pancreatic function tests and/or imaging procedures, whereas the mild form of the disease or its early stages are more difficult to detect and are often only retrospectively diagnosed. The reliability of imaging procedures depends mainly on the experience of the investigator, whereas the reliability of the pancreatic function tests depends on the patient's compliance. Further diagnostic procedures should be performed in accordance with the mayor symptom. If weight loss, diarrhea and/or steatorrhea dominate, indirect pancreatic function tests are required. Normal results of these tests usually exclude a pancreatogenic origin. If epigastric complaints dominate, ERCP should be performed prior to the indirect pancreatic function tests. If all findings are normal and all other upper abdominal diseases ruled out, but--due to persisting symptoms--chronic pancreatitis is still suspected, a direct function test should be performed to confirm or refute the tentative diagnosis. Chronic pancreatitis may--in its early stage--only involve the small pancreatitic ducts, not visible on ERCP examination, and indirect pancreatic function tests may show falsely normal test results.