Conservative management of chronic pancreatitis

Abstract

Chronic pancreatitis is characterised by progressive loss of exocrine and endocrine function of the pancreas. In Western countries, the majority of cases are associated with alcohol abuse. The cardinal clinical features of chronic pancreatitis are pain, maldigestion and diabetes. The pain of chronic pancreatitis is often difficult to treat. Analgesics form the cornerstone of pain therapy and the development of newer agents such as Tramodol which effectively relieve pancreatic pain without the side effects of opioid analgesics represents a potentially useful advance. Other approaches to pain therapy including inhibition of secretion and antioxidants have also been described, but there is a lack of well controlled trials of these modalities, making it difficult to assess their efficacy. Maldigestion due to exocrine insufficiency is treated with pancreatic enzyme replacement. For adequate treatment, it is essential that a critical concentration of exogenous digestive enzymes (at least 5% of normal enzyme output) is delivered to the gut. Recent studies indicate that a high fat, high protein diet can significantly improve the efficacy of exogenously administered lipase. Diabetes secondary to chronic pancreatitis is often difficult to control, particularly due to the susceptibility of patients to hypoglycaemic episodes. Overt deficiencies of nutrients such as vitamins are rare in chronic pancreatitis and the role of nutritional supplementation is limited to the correction of specific, clinically evident deficiencies. The major aim of conservative treatment of chronic pancreatitis is to effectively alleviate pain, maldigestion and diabetes, and consequently, to improve the patient's quality of life.