Abstract and Introduction
Abstract
Purpose of review We review important new clinical observations in chronic pancreatitis made in the past year.
Recent findings Cigarette smoking is a dose-dependent risk factor for acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis. A minority of chronic alcohol consumers develop recurrent acute pancreatitis but very heavy drinking associates with chronic pancreatitis. More patients with alcohol-induced chronic pancreatitis have cirrhosis than patients with cirrhosis have chronic pancreatitis (39 vs. 18%). Most patients with asymptomatic hyperenzymemia have no pancreatic lesions. Pancreatic calcifications are most frequently due to chronic pancreatitis, followed by cystic neoplasms and other disorders. The new Rosemont consensus classification of endoscopic ultrasonography criteria for chronic pancreatitis is unvalidated. Zinc deficiency correlates only with severe chronic pancreatitis and the fecal elastase test is an inaccurate marker of pancreatic steatorrhea. Patients commonly receive insufficient lipase to abolish pancreatic steatorrhea. Ultrastructural neuropathies are common to chronic pancreatitis and pancreatic cancer and correlate with pain severity.
Summary Results of this year's investigations further elucidated risk factors for pancreatic disease, the natural history of alcoholic pancreatitis, the differential diagnosis of pancreatic calcifications, the diagnosis of chronic pancreatitis with the Rosemont criteria, the limited diagnostic utility of fecal elastate test and zinc measurements, the proper dosing of pancreatic enzyme supplements, and treatment of pancreatic pain.
Introduction
Chronic pancreatitis is a progressive inflammatory and fibrotic disease of the pancreas with hallmark features of abdominal pain, malabsorption, malnutrition, diabetes mellitus, and pancreatic calcifications. Currently, there is no definitive medical treatment for pancreatic inflammation, fibrosis, or pain. In this review, we focus on environmental risk factors, natural history, coexistent alcoholic chronic pancreatitis and cirrhosis, asymptomatic pancreatic hyperenzymemia, diagnosis, pancreatic calcifications, pancreatic function testing, and treatment of exocrine pancreatic insufficiency (EPI) and pain.