Pancreatitis crónica

Abstract

Chronic pancreatitis (CP) is a disease in which, due to different causes, the pancreatic tissue is replaced by fibrous tissue. This results in loss of both endocrine and exocrine function. This may happen due to different causes, often involving various risk factors. Investigating these causes is important due to their different therapeutic and prognostic implications, which are listed in the TIGAR-O classification. The clinical manifestations of CP occur when most of the organ's function has been lost. They include chronic abdominal pain, exocrine pancreatic insufficiency, and endocrine pancreatic insufficiency. There is no gold standard test for diagnosing CP that can provide a definitive diagnosis, but epidemiological, clinical, radiological (mainly endoscopic ultrasound and magnetic resonance cholangiopancreatography), and analytical tests (stool elastase test, complete nutritional study, and, if available, a 13C-labeled mixed triglyceride breath test) must be jointly evaluated. It is not necessary to obtain a histological specimen. Treatment is focused on pain management with medical, endoscopic, or surgical treatment in the most refractory cases; management of exocrine pancreatic insufficiency with lipase enzyme supplementation if available; management of endocrine pancreatic insufficiency (antidiabetics and insulin); and control of risk factors (tobacco use and alcohol use disorder).