Konservative Therapie der chronischen Pankreatitis

Abstract

Conservative Therapy of Patients with Chronic Pancreatitis The symptomatic therapy of chronic pancreatitis can be divided into several arms: abstinence from alcohol to achieve social reintegration, improvement of compliance, retardation of disease progression, and reduction of complications; abstinence from nicotine to retard arteriosclerosis and further nicotine-dependent complications. Pain therapy is dependent on the pathogenesis of pain and should, therefore, be causal. Drugs can be applied via the oral, sublingual, intravenous, transdermal, peridural, or intrathecal route. In severe cases a plexus celiacus blockade is necessary. Interventional endoscopy has its indication to treat distal stenoses of the bile and/or pancreatic duct, to drain pseuodcysts and to remove, via extracorporeal shock wave lithotripsy, prepapillary pancreatic duct stones. Interventional endoscopy has probably no benefit on the long-term course of chronic pancreatitis. Therapy of exocrine pancreatic insufficiency has the intention to improve maldigestion. Usually, porcine pancreatic extracts (acid resistant microtablets or micropellets) or conventional extracts in case of a lack of gastric acid are used. Probably, in the future, genetically synthesized microbial acid-resistant lipase will have the potential to solve the partially existing problem of lipase destruction by acid and protease. Lipid-soluble vitamins, medium-chain triglycerides, and a fat-restricted diet are only necessary in cases of severe maldigestion which cannot be markedly improved by application of porcine pancreatic extracts. Therapy of endocrine insufficiency usually needs the application of insulin. Intensified insulin therapy should be avoided in patients who are not compliant. Surgery may be indicated due to pain, complications or suspicion of cancer.