Chronic pancreatitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Chronic pancreatitis management:
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
General recommendations:
Most of the patients usually improve following the general recommendations with only a few requiring analgesics.
(a) Smoking cessation:
- Smoking cessation may
- Delay the progression of chronic pancreatitis
- Decrease the risk of pancreatic cancer[2]
(b) Cessation of alcohol intake:
- Alcohol cessation may help in symptomatic improvement particularly in alcohol induced chronic pancreatitis.
- Alcohol intake is associated with increased mortality in pateints with alcohol induced chronic pancreatitis.[3]
(c) Small meals and hydration
Medical Therapy:
1.Pancreatic Enzyme Supplementation:
2.Analgesics:
3.Antioxidants:
4.Specialized approaches:
4.1 Celiac nerve block
4.2 Endoscopic therapy
4.3 Extracorporeal shock wave lithotripsy
4.4 Radiation
Management of Steatorrhea:
1. Dietary modification
2. Lipase supplementation
3. Vitamin supplementation
4. Medium chain triglycerides
Management of glucose intolerance:
Management of other pancreatic complications:
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.
- ↑ Maisonneuve P, Lowenfels AB, Müllhaupt B, Cavallini G, Lankisch PG, Andersen JR, Dimagno EP, Andrén-Sandberg A, Domellöf L, Frulloni L, Ammann RW (2005). "Cigarette smoking accelerates progression of alcoholic chronic pancreatitis". Gut. 54 (4): 510–4. doi:10.1136/gut.2004.039263. PMC 1774435. PMID 15753536.
- ↑ Steer ML, Waxman I, Freedman S (1995). "Chronic pancreatitis". N. Engl. J. Med. 332 (22): 1482–90. doi:10.1056/NEJM199506013322206. PMID 7739686.