Chronic pancreatitis and exocrine pancreatic insufficiency

Abstract

Chronic pancreatitis is a fibro-inflammatory disease of the pancreas characterized by inflammation and fibrosis. It is associated with excessive alcohol consumption and smoking, although a number of other risk factors are increasingly recognized, including a genetic predisposition. Patients typically present with upper abdominal pain, weight loss and changes in bowel habits caused by exocrine pancreatic insufficiency. Additionally, chronic pancreatitis is frequently complicated by post-pancreatitis diabetes mellitus and a number of other conditions, including common bile duct stenosis and duodenal obstruction. Because of malabsorption, patients also have an increased risk of osteoporosis and low-energy fractures. Alcohol abstinence and smoking cessation are key elements of management. Pain is often the most prominent symptom and has a multifactorial aetiology that requires a multidisciplinary treatment approach, including specialized endoscopic and surgical expertise. Exocrine pancreatic insufficiency is treated by enzyme replacement therapy with careful monitoring of patients’ macro- and micronutritional state, including a systematic assessment of bone health. Post-pancreatitis diabetes mellitus requires special therapeutic considerations because of a high risk of hypoglycaemia. Most patients obtain acceptable quality of life when adhering to modern treatment recommendations.