Chronic pancreatitis

Czech version

Authors: T. Hucl; P. Mačinga
Authors‘ workplace: Klinika hepatogastroenterologie, Institut klinické a experimentální medicíny, Praha
Published in: Kardiol Rev Int Med 2014, 16(3): 244-251
Category: Internal Medicine

Overview

Chronic pancreatitis is a progressive inflammatory disease characterized by the replacement of the pancreatic gland by fibrous tissue, resulting in an impairment of exocrine and endocrine function. Under the local conditions, the disease can usually be attributed to chronic alcohol abuse in combination with genetic, metabolic and environmental factors. Pancreatic stellate cells play a key role in the complex pathogenesis of the disease by producing fibrous tissue in response to various stimuli. The main symptoms include pain, maldigestion and diabetes. The management of patients with chronic pancreatitis requires an accurate diagnosis, recognition of aetiology, evaluation of symptoms and complications and adequate therapy often utilizing a multidisciplinary team. The goals of treatment are pain control, replacement of the lost digestive function with pancreatic enzymes, insulin therapy in diabetes patients and treatment of complications (for example bile duct stricture, pseudocyst). In the treatment of pain, non‑narcotic analgesics, opioids or their combinations with antipsychotics are used; in the treatment of pancreatic exocrine insufficiency preparations of pancreatin are administered. Patients who do not respond to medical therapy are candidates for interventional treatment. Endoscopic therapy is less effective than surgical therapy; however it often remains the method of choice for its safety and for preserving the possibility of a later surgical procedure. Endoscopy can be used with the help of extracorporeal lithotripsy to treat pancreatic duct stones, but more often it is used to treat pancreatic and bile duct strictures or to treat pseudocysts. Symptomatic pseudocysts are routinely drained transluminally under endosonography guidance. Surgical therapy, either in the form of drainage or resection, is very effective, but has a significant risk of complications.

Keywords:
chronic pancreatitis – alcohol – smoking – pain – pancreatic exocrine insufficiency

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