[Therapy of chronic pancreatitis]

Therapy of chronic pancreatitis is dependent on the stage of the disease and its possible complications. A conservative therapy has to focus 1) on pain relief which implicates an understanding of the multiple causes of pain, 2) on therapy of the exocrine insufficiency by application of the appropriate pancreatic enzymes, dietary regimes, and substitution of fat soluble vitamins, and finally 3) therapy of endocrine insufficiency with insulin. The most important therapy is abstinence from alcohol. One special topic of this review is a discussion about the problem of "negative feedback regulation" of the exocrine pancreas with its question whether one can inhibit pancreatic secretion by application of pancreatic enzymes and, thus, reach a pain relieving effect. Various surgical procedures and possibilities of interventional endoscopy are briefly discussed.