Introduction

Chronic pancreatitis is an inflammatory condition which can ultimately affect both the exocrine and endocrine functions of the pancreas. Around 80% of cases are due to alcohol excess with up to 20% of cases being unexplained.

Epidemiology

  • Incidence: 5.00 cases per 100,000 person-years
  • Peak incidence: 40-50 years
  • Sex ratio: more common in males 4:1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Aetiology

Other than alcohol, causes include:
  • genetic: cystic fibrosis, haemochromatosis
  • ductal obstruction: tumours, stones, structural abnormalities including pancreas divisum and annular pancreas

Clinical features

Features
  • pain is typically worse 15 to 30 minutes following a meal
  • steatorrhoea: symptoms of pancreatic insufficiency usually develop between 5 and 25 years after the onset of pain
  • diabetes mellitus develops in the majority of patients. It typically occurs more than 20 years after symptom begin

Investigations

Investigation
  • abdominal x-ray shows pancreatic calcification in 30% of cases
  • CT is more sensitive at detecting pancreatic calcification. Sensitivity is 80%, specificity is 85%
  • functional tests: faecal elastase may be used to assess exocrine function if imaging inconclusive

Management

Management
  • pancreatic enzyme supplements
  • analgesia
  • antioxidants: limited evidence base - one study suggests benefit in early disease