ACG Clinical Guideline: Chronic Pancreatitis

Area of Science:

• Gastroenterology
• Pancreatology
• Pathology

Background:

• Chronic pancreatitis (CP) is traditionally viewed as irreversible pancreatic inflammation with exocrine and endocrine dysfunction.
• A recent paradigm shift emphasizes early diagnosis of the underlying pathologic process and holistic management.
• The current definition considers CP a fibroinflammatory syndrome linked to risk factors and persistent responses to injury.

Purpose of the Study:

• To provide an evidence-based guideline for diagnosing and managing chronic pancreatitis.
• To offer a practical approach for general gastroenterologists.
• To update the understanding of CP diagnosis and management.

Main Methods:

• Review of current literature and diagnostic criteria for chronic pancreatitis.
• Analysis of traditional and emerging diagnostic modalities.
• Synthesis of evidence for management strategies.

Main Results:

• CP is characterized by abdominal pain, exocrine insufficiency, and diabetes, with variable onset.
• Common causes include alcohol, tobacco, genetic factors, and recurrent acute pancreatitis.
• Diagnosis relies on cross-sectional imaging, with endoscopic ultrasonography and function tests as secondary tools.

Conclusions:

• Total pancreatectomy is the only cure but is often impractical due to selection difficulties and complications.
• A shift towards early diagnosis and comprehensive management is crucial for altering the disease course.
• Guidelines are needed to standardize the approach to CP diagnosis and management.