{"title":"Chronic pancreatitis and exocrine pancreatic insufficiency","authors":"Søren Schou Olesen","doi":"10.1016/j.mpmed.2024.02.004","DOIUrl":null,"url":null,"abstract":"<div><p>Chronic pancreatitis is a fibro-inflammatory disease of the pancreas characterized by inflammation and fibrosis. It is associated with excessive alcohol consumption and smoking, although a number of other risk factors are increasingly recognized, including a genetic predisposition. Patients typically present with upper abdominal pain, weight loss and changes in bowel habits caused by exocrine pancreatic insufficiency. Additionally, chronic pancreatitis is frequently complicated by post-pancreatitis diabetes mellitus and a number of other conditions, including common bile duct stenosis and duodenal obstruction. Because of malabsorption, patients also have an increased risk of osteoporosis and low-energy fractures. Alcohol abstinence and smoking cessation are key elements of management. Pain is often the most prominent symptom and has a multifactorial aetiology that requires a multidisciplinary treatment approach, including specialized endoscopic and surgical expertise. Exocrine pancreatic insufficiency is treated by enzyme replacement therapy with careful monitoring of patients’ macro- and micronutritional state, including a systematic assessment of bone health. Post-pancreatitis diabetes mellitus requires special therapeutic considerations because of a high risk of hypoglycaemia. Most patients obtain acceptable quality of life when adhering to modern treatment recommendations.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicine (Abingdon, England : UK ed.)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1357303924000409","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Chronic pancreatitis is a fibro-inflammatory disease of the pancreas characterized by inflammation and fibrosis. It is associated with excessive alcohol consumption and smoking, although a number of other risk factors are increasingly recognized, including a genetic predisposition. Patients typically present with upper abdominal pain, weight loss and changes in bowel habits caused by exocrine pancreatic insufficiency. Additionally, chronic pancreatitis is frequently complicated by post-pancreatitis diabetes mellitus and a number of other conditions, including common bile duct stenosis and duodenal obstruction. Because of malabsorption, patients also have an increased risk of osteoporosis and low-energy fractures. Alcohol abstinence and smoking cessation are key elements of management. Pain is often the most prominent symptom and has a multifactorial aetiology that requires a multidisciplinary treatment approach, including specialized endoscopic and surgical expertise. Exocrine pancreatic insufficiency is treated by enzyme replacement therapy with careful monitoring of patients’ macro- and micronutritional state, including a systematic assessment of bone health. Post-pancreatitis diabetes mellitus requires special therapeutic considerations because of a high risk of hypoglycaemia. Most patients obtain acceptable quality of life when adhering to modern treatment recommendations.