Diagnostic and therapeutic management of chronic pancreatitis

Natural history: Alcoholism is a common cause of chronic calcifying pancrea titis. Abdominal pain, weight loss and acute complications are the early ma nifestations. Besides chronic pain, about 80% of the patients develop acute pancreatitis, pseudocysts, compression of the main bile duct, serous effus ion or digestive bleeding during the first five years of the disease course . Painful episodes are more frequent after S to 10 years, with a risk of ja undice and persistent pseudocyst formation. Chronic course: Beyond 10 years, calcified stones and fibrosis progressivel y replace the pancreas parenchyma. Painful events become more parse and aft er 15 years, diabetes and exocrine insufficiency predominate. Treatment: Abstention from alcoholic beverages, analgesia administration an d balanced diet are essential therapeutic elements. Insulin is required for the diabetes and pancreas extracts in gastroprotected microcapsules are ne eded to compensate for the chronic exocrine insufficiency. This medical tre atment may be able to control pain but interventional radiology (pseudocyst drainage, antalgesic infiltration of the celiac plexus), interventional en doscopy (pseudocyst drainage, biliary stent, pancreatic endoprosthesis), or surgery (deviation of the bile ducts, wirsungojejunal derivation, exceptio nally resection) may also be required.