Chronic pancreatitis and exocrine pancreatic insufficiency

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 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 secondary diabetes mellitus (type 3c diabetes) 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 systematic assessment of bone health. Diabetes secondary to chronic pancreatitis requires special therapeutic considerations because of a high risk of hypoglycaemia. Most patients obtain an acceptable life quality when adhering to modern treatment recommendations.