Chronic pancreatitis: Complications and management

Chronic pancreatitis is characterized by progressive and irreversible loss of pancreatic exocrine and endocrine function. In the majority of cases, pa rticularly in Western populations, the disease is associated with alcohol a buse. The major complications of chronic pancreatitis include abdominal pai n, malabsorption, and diabetes. Of these, pain is the most difficult to tre at and is therefore the most frustrating symptom for both the patient and t he physician. While analgesics form the cornerstone of pain therapy, a numb er of other treatment modalities (inhibition of pancreatic secretion, antio xidants, and surgery) have also been described. Unfortunately, the efficacy of these modalities is difficult to assess, principally because of the lac k of properly controlled clinical trials. Replacement of pancreatic enzymes (particularly lipase) in the gut is the mainstay of treatment for malabsor ption; the recent discovery of a bacterial lipase (with high lipolytic acti vity and resistance to degradation in gastric and duodenal juice) represent s an important advance that may significantly increase the efficacy of enzy me replacement therapy by replacing the easily degradable porcine lipase fo und in existing enzyme preparations. Diabetes secondary to chronic pancreat itis is difficult to control and its course is often complicated by hypogly caemic attacks. Therefore, it is essential that caution is exercised when t reating this condition with insulin. This paper reviews recent research and prevailing concepts regarding the three major complications of chronic pan creatitis noted above. A comprehensive discussion of current opinion on cli nical issues relating to the other known complications of chronic pancreati tis such as pseudocysts, venous thromboses, biliary and duodenal obstructio n, biliary cirrhosis, and pancreatic cancer is also presented.