Chronic Pancreatitis

Vege, Santhi Swaroop M.D.
Chari, Suresh T. M.D.

From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (S.S.V.); and the Department of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, University of Texas M.D. Anderson Cancer Center, Houston (S.T.C.).

Caren G. Solomon, M.D., M.P.H., Editor

Dr. Chari can be contacted at [email protected] or at the Department of Gastroenterology, Hepatology and Nutrition, Division of Internal Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

New England Journal of Medicine 386(9):p 869-878, March 3, 2022. | DOI: 10.1056/NEJMcp1809396

Key Clinical Points

Chronic Pancreatitis

Chronic pancreatitis, which is commonly associated with alcohol use, smoking, or genetic risk factors, often manifests as recurrent bouts of abdominal pain or pancreatitis. Characteristic imaging findings include pancreatic stones, dilated ducts, and atrophy.
Complications of chronic pancreatitis include pseudocysts, biliary strictures, exocrine and endocrine pancreatic insufficiency, bone loss, and pancreatic cancer; there is currently no effective early detection strategy for pancreatic cancer.
Exocrine insufficiency causing steatorrhea leads to weight loss, sarcopenia, and deficiencies of fat-soluble vitamins and other micronutrients and is mitigated by treatment with pancreatic-enzyme replacement.
Strategies for managing chronic abdominal pain include medical therapies (analgesic agents, limited use of narcotics, antioxidants, and neuromodulators), endoscopic treatment (pancreatic stenting with or without extracorporeal shockwave lithotripsy), and surgical interventions (duct drainage and resection procedures), as well as behavioral interventions for centrally mediated pain.