From Current Opinion in Gastroenterology

Chronic Pancreatitis

Matthew J. DiMagno; Eugene P. DiMagno

Authors and Disclosures

Posted: 12/08/2011; Curr Opin Gastroenterol. 2011;27(5):452-459. © 2011 Lippincott Williams & Wilkins

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Abstract and Introduction

Abstract

Purpose of review: We review important new clinical observations in chronic pancreatitis made in the past year.
Recent findings: Tropical pancreatitis associates with SPINK1 and/or CFTR gene mutations in approximately 50% of patients, similar to the frequency in idiopathic chronic pancreatitis. Corticosteroids increase secretin-stimulated pancreatic bicarbonate concentrations in autoimmune pancreatitis (AIP) by restoring mislocalized CFTR protein to the apical ductal membrane. Most patients with asymptomatic hyperenzymemia have pancreatic lesions of unclear significance or no pancreatic lesions. Common pitfalls in the use of diagnostic tests for exocrine pancreatic insufficiency (EPI) confound interpretation of findings in irritable bowel syndrome and severe renal insufficiency. Further study is needed to improve the accuracy of endoscopic ultrasonography (EUS) to diagnose chronic pancreatitis. Celiac plexus block provides short-term pain relief in a subset of patients.
Summary: Results of this year's investigations further elucidated the genetic associations of tropical pancreatitis, a reversible mislocalization of ductal CFTR in AIP, the association of asymptomatic pancreatic hyperenzymemia with pancreatic disorders, limitations of diagnostic tests for EPI, diagnosis of chronic pancreatitis by EUS and endoscopic pancreatic function testing and treatment of pain.

Introduction

Chronic pancreatitis is a progressive inflammatory and fibrotic disease of the pancreas with hallmark features of abdominal pain, malabsorption, malnutrition, diabetes mellitus and pancreatic calcifications. Currently, there is no definitive medical treatment for pancreatic inflammation, fibrosis or pain. In this review we focus on genetic associations of tropical pancreatitis, reversible mislocalization of ductal cystic fibrosis transmembrane conductance regulator (CFTR) in autoimmune pancreatitis (AIP), asymptomatic pancreatic hyperenzymemia, testing for exocrine pancreatic insufficiency (EPI), diagnosis of chronic pancreatitis by endoscopic ultrasound (EUS) and endoscopic pancreatic function testing (ePFT) and neuropathic pain of chronic pancreatitis.

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