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Chronic pancreatitis
Matthew J DiMagno1, Eugene P DiMagno
1Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0682, USA. mdimagno@umich.edu
Current Opinion in Gastroenterology
|August 10, 2010
Summary
Cigarette smoking and heavy alcohol use are key risk factors for pancreatitis. New findings clarify diagnosis, risk factors, and treatment for chronic pancreatitis, including pain management.
Area of Science:
- Gastroenterology
- Pancreatology
- Clinical Medicine
Background:
- Chronic pancreatitis is a complex condition with multifactorial etiology.
- Understanding evolving risk factors and diagnostic criteria is crucial for patient management.
Purpose of the Study:
- To review significant clinical observations in chronic pancreatitis from the past year.
- To update knowledge on risk factors, diagnosis, and treatment of pancreatic diseases.
Main Methods:
- Literature review of recent clinical observations and investigations.
- Analysis of findings related to risk factors, natural history, and diagnostic tools.
Main Results:
- Cigarette smoking is a dose-dependent risk factor for acute and chronic pancreatitis.
- Heavy alcohol consumption is linked to chronic pancreatitis; alcohol-induced chronic pancreatitis patients have higher cirrhosis rates.
- Pancreatic calcifications are often due to chronic pancreatitis, but cystic neoplasms should be considered.
- The Rosemont criteria for diagnosing chronic pancreatitis require further validation.
- Fecal elastase test is inaccurate for steatorrhea; zinc deficiency correlates with severe chronic pancreatitis.
- Ultrastructural neuropathies in chronic pancreatitis correlate with pain severity.
Conclusions:
- Recent research clarifies risk factors for pancreatic disease, including smoking and alcohol.
- The natural history of alcoholic pancreatitis and the differential diagnosis of pancreatic calcifications are better understood.
- Diagnostic utility of Rosemont criteria, fecal elastase, and zinc measurements is limited.
- Optimal pancreatic enzyme supplementation and pain management strategies are highlighted.
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