Chronic pancreatitis medical therapy: Difference between revisions
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* Management of complications<ref name="pmid18319401">{{cite journal |vauthors=Callery MP, Freedman SD |title=A 21-year-old man with chronic pancreatitis |journal=JAMA |volume=299 |issue=13 |pages=1588–94 |year=2008 |pmid=18319401 |doi=10.1001/jama.299.9.jrr80001 |url=}}</ref> | * Management of complications<ref name="pmid18319401">{{cite journal |vauthors=Callery MP, Freedman SD |title=A 21-year-old man with chronic pancreatitis |journal=JAMA |volume=299 |issue=13 |pages=1588–94 |year=2008 |pmid=18319401 |doi=10.1001/jama.299.9.jrr80001 |url=}}</ref> | ||
=== | === Pain management: === | ||
Pain is managed in a stepwise approach of | |||
* General recommendations | |||
* Pancreatic enzyme replacement | |||
* Analgesics | |||
* Other invasive procedures | |||
===Pancreatic Enzyme Supplementation:=== | |||
=== Management of complications: === | |||
Replacement [[Digestive enzyme#Pancreatic enzymes|pancreatic enzymes]] are often effective in treating the malabsorption and [[steatorrhea]]. However, the outcome from 6 randomized trials has been inconclusive regarding pain reduction.<ref name="pmid9721175">{{cite journal |author=Warshaw AL, Banks PA, Fernández-Del Castillo C |title=AGA technical review: treatment of pain in chronic pancreatitis |journal=Gastroenterology |volume=115 |issue=3 |pages=765–76 |year=1998 |pmid=9721175 |doi=10.1016/S0016-5085(98)70157-X}}</ref> | Replacement [[Digestive enzyme#Pancreatic enzymes|pancreatic enzymes]] are often effective in treating the malabsorption and [[steatorrhea]]. However, the outcome from 6 randomized trials has been inconclusive regarding pain reduction.<ref name="pmid9721175">{{cite journal |author=Warshaw AL, Banks PA, Fernández-Del Castillo C |title=AGA technical review: treatment of pain in chronic pancreatitis |journal=Gastroenterology |volume=115 |issue=3 |pages=765–76 |year=1998 |pmid=9721175 |doi=10.1016/S0016-5085(98)70157-X}}</ref> | ||
Revision as of 13:20, 6 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
The goals of management are:
- Pain control
- Management of pancreatic insufficiency by pancreatic enzyme replacement
- Management of complications[1]
Pain management:
Pain is managed in a stepwise approach of
- General recommendations
- Pancreatic enzyme replacement
- Analgesics
- Other invasive procedures
Pancreatic Enzyme Supplementation:
Management of complications:
Replacement pancreatic enzymes are often effective in treating the malabsorption and steatorrhea. However, the outcome from 6 randomized trials has been inconclusive regarding pain reduction.[2]
While the outcome of trials regarding pain reduction with pancreatic enzyme replacement is inconclusive, some patients do have pain reduction with enzyme replacement and since they are relatively safe, giving enzyme replacement to a chronic pancreatitis patient is an acceptable step in treatment for most patients. Treatment may be more likely to be successful in those without involvement of large ducts and those with idiopathic pancreatitis. Patients with alcoholic pancreatitis may be less likely to respond.
References
- ↑ Callery MP, Freedman SD (2008). "A 21-year-old man with chronic pancreatitis". JAMA. 299 (13): 1588–94. doi:10.1001/jama.299.9.jrr80001. PMID 18319401.
- ↑ Warshaw AL, Banks PA, Fernández-Del Castillo C (1998). "AGA technical review: treatment of pain in chronic pancreatitis". Gastroenterology. 115 (3): 765–76. doi:10.1016/S0016-5085(98)70157-X. PMID 9721175.