[Chronic pancreatitis: conservative therapy]

Chronic pancreatitis is mainly due to longstanding alcoholism. In general treatment is based on drug therapy. The clinical appearance is determined by chronic pain, steatorrhoea and eventually by the onset of diabetes mellitus. Beyond other measures total avoidance of alcohol ingestion provides a condition of a more benign course of the disease. Treatment of pain consists of symptomatic therapy and prescription of pancreatic enzymes in order to lessen pancreatic stimulation by inhibition of feedback mechanisms. The same principle applies to the prescription of octreotide which is used only in selected cases since it has failed to prove general effectiveness. Symptoms of exocrine insufficiency are alleviated by substitution of pancreatic enzymes. Attention must be directed on dose and preparation of pancreatic enzymes being used. Treatment of pancreatogenic diabetes resembles therapy of type I diabetes mellitus. In principle treatment of chronic pancreatitis should be adjusted to the highly variable clinical appearance of the disease and requires a systematic approach. It has to be kept in mind that some complications of chronic pancreatitis [e.g. pseudocysts] may require surgical intervention.