The current state of diagnosis and management of chronic pancreatitis
DOI:
https://doi.org/10.22516/25007440.301Keywords:
chronic pancreatitis, diagnosis, treatmentAbstract
Chronic pancreatitis (CP) is an inflammatory condition that leads to fibrosis, damage, and even destruction of the pancreatic parenchyma and ducts. These permanent changes can alter pancreatic exocrine and endocrine functioning, cause biliary and pancreatic stenosis, lead to formation of pseudocysts and even increase the possibility of developing pancreatic cancer. The main clinical characteristic is pain which significantly alters quality of life. To diagnose the CP, we have direct and indirect functional tests and the pancreatic structure test.
The great challenge of these methods is early diagnosis, but this is difficult due to the subtlety of changes.
Once CP is diagnosed, management must be staggered. Medical management is the initial step which can be followed by endoscopic management, surgical management, and for the most difficult cases a combination of these. The goal is to manage and understand the whole patient and illness to provide the best possible quality of life. This review article focuses on CP diagnosis and management in light of the currently available evidence.
Downloads
References
Trikudanathan G, Navaneethan U, Swaroop S. Modern treatment of patients with chronic pancreatitis, Gastroenterol Clin N Am. 2012;41:63-76. doi: https://doi.org/10.1016/j.gtc.2011.12.009.
Lizarazo J. Fisiopatología de la pancreatitis crónica. Rev Col Gastroenterol. 2008;(3):290-8.
Yang D, Forsmark C. Chronic pancreatitis. Curr Opin Gastroenterol. 2017;33:396-403. doi: https://doi.org/10.1097/MOG.0000000000000377.
Siddiqui U, Hawes R. Chronic pancreatitis. En: Chandrasekhara V, Khashab M, Elmunzer BJ, Muthusamy VR. Clinical Gastrointestinal Endoscopy. 3ª edición. Elsevier. 2019. p. 686-98. doi: https://doi.org/10.1016/C2014-0-03901-9.
Anaizi A, Hart P, Conwell D. Diagnosing chronic pancreatitis. Dig Dis Sci. 2017;62(7):1713-20. doi: https://doi.org/10.1007/s10620-017-4493-2.
Nikfarjam M, Wilson J, Smith R, Australasian Pancreatic Club Pancreatic Enzyme Replacement Therapy Guidelines Working Group. Diagnosis and management of pancreatic exocrine insufficiency. Med J Aust. 2017;207(4):161-5. doi: https://doi.org/10.5694/mja16.00851.
Conwell D, Lee L, Yadav D, Longnecker DS, Miller FH, Mortele KJ, et al. American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: evidence-based report on diagnostic guidelines. Pancreas. 2014;43(8):1143-62. doi: https://doi.org/10.1097/MPA.0000000000000237.
Vanga RR, Tansel A, Sidiq S, El-Serag HB, Othman MO, et al. Diagnostic performance of measurement of fecal elastase-1 in detection of exocrine pancreatic insufficiency - systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16(8):1220-8.e4. doi: 10.1016/j.cgh.2018.01.027.
Domínguez-Muñoz JE, Nieto L, Vilarino M, Lourido MV, Iglesias-García J, et al. Development and diagnostic accuracy of a breath test for pancreatic exocrine insufficiency in chronic pancreatitis. Pancreas. 2016;45:241-7. doi: https://doi.org/10.1097/MPA.0000000000000434.
Frøkjær JB, Akisik F, Farooq A, Akpinar B, Dasyam A, Drewes AM, et al. Guidelines for the diagnostic cross sectional imaging and severity scoring of chronic pancreatitis. Pancreatology. 2018;18(7):764-73. doi: 10.1016/j.pan.2018.08.012.
Tirkes T. Chronic pancreatitis what the clinician wants to know from MR Imaging, Magn Reson Imaging Clin N Am. 2018;26(3):451-61. doi: https://doi.org/10.1016/j.mric.2018.03.012.
Irisawa A, Shibukawa G, Abe Y, Nikaido A, Inbe K, Hoshi K. Endosonographic diagnosis of chronic pancreatitis. J Gastroint Dig Syst. 2013;S2:005. doi: https://doi.org/10.4172/2161-069X.S2-005.
Cañadas R, Aponte D, Albis R, Sabbagh LC. Utilidad del ultrasonido endoscópico en el diagnóstico de pancreatitis crónica: la importancia de un diagnóstico temprano. Rev Col Gastroenterol. 2013;28(3):226-34.
Arango L, Diaz C. Ultrasonografía endoscópica en patologías del páncreas. Rev Med Clin Las Cond. 2015;(5):556-710.
Sabbagh L, Aponte D, Cañadas R, Torres M, Álvarez E, Prieto RG, et al. Guía de práctica clínica para el uso de ultrasonido endoscópico en pancreatitis crónica, lesiones quísticas y sólidas del páncreas en adultos. Rev Col Gastroenterol. 2015;(l1):97-104.
Sheel A, Baron R, Sarantitis I, Ramesh J, Ghaneh P, Raraty MGT, et al. The diagnostic value of Rosemont and Japanese diagnostic criteria for 'indeterminate', 'suggestive', 'possible' and 'early' chronic pancreatitis. Pancreatology. 2018;18(7):774-84. doi: https://doi.org/10.1016/j.pan.2018.08.002.
Witt H, Apte MV, Keim, Wilson JS. Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology. 2007;132:1557-73. doi: https://doi.org/10.1053/j.gastro.2007.03.001.
Catalano M, Sahai A, Levy M, Romagnuolo J, Wiersema M, Brugge W, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointes Endos. 2009;(7):1251-61. doi: https://doi.org/10.1016/j.gie.2008.07.043.
Shimosegawa T, Kataoka K, Kamisawa T, Miyakawa H, Ohara H, Ito T, et al. The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol. 2010;45:584-91. doi: https://doi.org/10.1007/s00535-010-0242-4.
Domínguez-Muñoz J, Iglesias-García J, Castiñeira Alvariño M, Luaces Regueira M, Lariño-Noia J. EUS elastography to predict pancreatic exocrine insufficiency in patients with chronic pancreatitis, Gastrointest Endosc. 2015;81:136-42. doi: https://doi.org/10.1016/j.gie.2014.06.040.
Czul F, Coronel E, Done JA. Una actualización de pancreatitis crónica: artículo de revisión. Rev Gastroenterol Perú. 2017;37(2):146-55.
Han S, Kheder J, Bocelli L, Fahed J, Wachholtz A, Seward G, et al. Smoking cessation in a chronic pancreatitis population. Pancreas. 2016;45:1303-8. doi: https://doi.org/10.1097/MPA.0000000000000641.
Duggan S. Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis. Proceedings Nutrition Soc. 2017;76:484-94. doi: 10.1017/S0029665117001045.
De la Iglesia D, Vallejo-Senra N, López-López A, Iglesias-Garcia J, Lariño-Noia J, Nieto-García L, et al. Pancreatic exocrine insufficiency and cardiovascular risk in patients with chronic pancreatitis (CP). A prospective, longitudinal cohort study. J Gastroenterol Hepatol. 2019;34(1):277-283. doi: https://doi.org/10.1111/jgh.14460.
Drewes AM, Bouwense S, Campbell CM, Ceyhand GO, Delhaye M, Demir IE, et al. Guidelines for the understanding and management of pain in chronic pancreatitis, Pancreatology. 2017;17(5):720-31. doi: https://doi.org/10.1016/j.pan.2017.07.006.
Domínguez J. Fisiopatología, diagnóstico y tratamiento de la insuficiencia pancreática exocrina en el paciente con pancreatitis crónica. Gastroenterol Hepatol. 2005;28(2):22-8. doi: https://doi.org/10.1157/13071383.
Majumder S, Chari ST. Chronic pancreatitis. Lancet. 2016;387(10031):1957-66. doi: 10.1016/S0140-6736(16)00097-0.
Adler J, Gardner T. Endoscopic therapies for chronic pancreatitis. Dig Dis Sci. 2017;1729-37. doi: https://doi.org/10.1007/s10620-017-4502-5.
Derdeyn J, Laleman W. Current role of endoscopic cholangioscopy. Curr op Gastroentrol. 2018;34(5):301-8. doi: 10.1097/MOG.0000000000000457.
Moran R, Elmunzer B. Endoscopic treatment of pain in chronic pancreatitis. Curr Opin Gastroenterol. 2018;34(6):469-76. doi: 10.1097/MOG.0000000000000480.

Downloads
Published
How to Cite
Issue
Section
License
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
Los autores/as ceden sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación en esta revista.
Los contenidos están protegidos bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.

Article metrics | |
---|---|
Abstract views | |
Galley vies | |
PDF Views | |
HTML views | |
Other views |