Chronic pancreatitis typically presents as chronic unrelenting pain with episodic flares. Although it is sometimes stated that chronic pancreatitis "burns out" over time, the duration of time over which this may occur is highly variable, if it occurs at all [1-4]. In addition, pancreatic endocrine and exocrine dysfunction may develop as the disease progresses, and a variety of complications can occur, including pseudocysts, bile duct or duodenal obstruction, pancreatic ascites, splenic vein thrombosis, and pseudoaneurysms.
Thus, the natural history of chronic pancreatitis is relatively bleak. Most therapies are aimed at "resting" the pancreas by minimizing exocrine pancreatic secretion; unfortunately, this is relatively ineffective. The goals of treatment include pain management, correction of pancreatic insufficiency, and management of complications . Therapy is similar in patients with acquired and hereditary pancreatitis.
The treatment of chronic pancreatitis (principally pain and pancreatic exocrine insufficiency) will be reviewed here. Other complications and their management, the etiology, clinical manifestations, and diagnosis of chronic pancreatitis are discussed separately. (See "Complications of chronic pancreatitis" and "Etiology and pathogenesis of chronic pancreatitis in adults" and "Causes of chronic pancreatitis in children and adolescents" and "Clinical manifestations and diagnosis of chronic pancreatitis in adults" and "Clinical manifestations and diagnosis of chronic pancreatitis in children".)
ESTABLISH A SECURE DIAGNOSIS
When there is a significant change in the pain pattern or a sudden onset of persistent symptoms, other potential etiologies (eg, peptic ulcer disease, biliary obstruction, pseudocysts, pancreatic carcinoma, and pancreatic duct stricture or stones) should be ruled out. It is difficult to be secure in the diagnosis of chronic pancreatitis, particularly in the first two to three years of disease when most diagnostic studies can be normal. (See "Clinical manifestations and diagnosis of chronic pancreatitis in adults" and "Clinical manifestations and diagnosis of chronic pancreatitis in children".)
The principal symptom of chronic pancreatitis is abdominal pain. The pain may range from occasional postprandial discomfort to debilitating persistent pain associated with nausea, vomiting, and weight loss. Pain control can be difficult in some cases. However, when considering the appropriate strategy to relieve pain, it should be recognized that placebo alone is effective in up to 30 percent of patients in most studies.