Materiały źródłowe

• #1 Chronic Pancreatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0315/p385.html

  Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis, and scarring. […] If chronic pancreatitis is suspected, contrast-enhanced computed tomography is the best imaging modality for diagnosis. […] Although most patients present with pain, pancreatitis is painless in roughly 10% to 20% of patients. […] The diagnosis of chronic pancreatitis is made based on a patient’s history, clinical presentation, and imaging findings. […] Diagnostic tests should be chosen based on their availability after consideration of risks and benefits. […] A meta-analysis of 43 studies that included more than 3,400 patients concluded that computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography have comparably high diagnostic accuracy for chronic pancreatitis; therefore, a stepwise approach based on cost, invasiveness, and availability is recommended.

• #2 Diagnosing Chronic Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478450/

  Chronic Pancreatitis (CP) is a debilitating disease that classically presents with recurrent bouts of acute pancreatitis, chronic abdominal pain as well as evidence of end organ damage. […] One of the biggest dilemmas is establishing a clear diagnosis. The arsenal of tests and imaging modalities available to providers is vast and this speaks to the often cumbersome task of making the diagnosis as there is usually not one image or test that reliably establishes CP. […] A true diagnosis of chronic pancreatitis may not be made simply by clinical history, imaging or function testing alone, but rather by evidence gathered by a combination of these diagnostic tools. […] Common presentations of disease include chronic abdominal pain, steatorrhea, diabetes, and weight loss of unexplained etiology.

• #3 Chronic Pancreatitis | Choose the Right Test

  https://arupconsult.com/content/pancreatitis-chronic

  Chronic pancreatitis includes a number of progressive inflammatory diseases, such as calcifying, chronic obstructive, and steroid-responsive or autoimmune chronic pancreatitis, which lead to pancreatic damage. […] Definitive diagnosis requires a combination of diagnostic tools, such as clinical examination, imaging, endoscopic procedures, and laboratory tests of pancreatic function. […] Diagnosis of chronic pancreatitis is difficult early in the disease course, and the laboratory tests used for chronic pancreatitis have limited sensitivity for early-stage disease. No single test can be used for diagnosis. […] Instead, a combination of clinical examination, functional testing, and imaging is typically needed to make a diagnosis. Risk factor classification systems for chronic pancreatitis, which account for laboratory and nonlaboratory factors, may help clinicians determine when to proceed with testing. The American Pancreatic Association (APA) recommends that indirect pancreatic function tests be used along with imaging to rule out cancer.

• #4 Chronic pancreatitis – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/chronic-pancreatitis/

  Chronic pancreatitis is hard to diagnose. This is because it is rare and the symptoms overlap with other more common conditions, such as Irritable Bowel Syndrome (IBS). […] Investigation aims to show abnormalities in the structure of the pancreas and/or how the pancreas works. A specialist gastroenterologist or specialist liver, biliary and pancreas surgeon usually supervises a person’s care. […] Unfortunately, there is no single test for chronic pancreatitis at this time, and many pancreatic cells can be damaged before abnormalities on tests show up. […] Once the damage and scarring advances and becomes more severe the pancreas damage may be detected by blood tests or scans. […] Investigations involve scans, such as CT and MRI scans which give the best pictures of the pancreas. […] The simplest test of the function of the pancreas (how good it is at producing digestive juices) is the faecal elastase test. […] Blood tests to look for vitamin and mineral deficiencies can also support a diagnosis of pancreatic exocrine insufficiency (PEI) and chronic pancreatitis.

• #5 Chronic Pancreatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0315/p385.html

  Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis, and scarring. […] If chronic pancreatitis is suspected, contrast-enhanced computed tomography is the best imaging modality for diagnosis. […] Although most patients present with pain, pancreatitis is painless in roughly 10% to 20% of patients. […] The diagnosis of chronic pancreatitis is made based on a patient’s history, clinical presentation, and imaging findings. […] Diagnostic tests should be chosen based on their availability after consideration of risks and benefits. […] A meta-analysis of 43 studies that included more than 3,400 patients concluded that computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography have comparably high diagnostic accuracy for chronic pancreatitis; therefore, a stepwise approach based on cost, invasiveness, and availability is recommended.

• #6 Diagnosing Chronic Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478450/

  Chronic Pancreatitis (CP) is a debilitating disease that classically presents with recurrent bouts of acute pancreatitis, chronic abdominal pain as well as evidence of end organ damage. […] One of the biggest dilemmas is establishing a clear diagnosis. The arsenal of tests and imaging modalities available to providers is vast and this speaks to the often cumbersome task of making the diagnosis as there is usually not one image or test that reliably establishes CP. […] A true diagnosis of chronic pancreatitis may not be made simply by clinical history, imaging or function testing alone, but rather by evidence gathered by a combination of these diagnostic tools. […] Common presentations of disease include chronic abdominal pain, steatorrhea, diabetes, and weight loss of unexplained etiology.

• #7 Pancreatitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/8103-pancreatitis

  Chronic pancreatitis is a long-term, progressive condition. It doesn’t go away and gets worse over time. It happens when the injury or damage to your pancreas never stops. Chronic pancreatitis will eventually do lasting damage to your pancreas, although it may take many years. Constant inflammation causes scarring of your pancreas tissues (fibrosis), which stops them from making enzymes and hormones. […] If your provider suspects you have chronic pancreatitis, they may order additional tests, including: Glucose test (to see whether your pancreas is still producing insulin effectively). Stool elastase test (to see if your pancreas is making enough digestive enzymes). Fecal fat analysis (to test for excess fat in your poop, a sign of fat malabsorption). Blood tests (to assess your nutritional status and whether you have enough fat-soluble vitamins in your blood).

• #8 Chronic Pancreatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0315/p385.html

  Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis, and scarring. […] If chronic pancreatitis is suspected, contrast-enhanced computed tomography is the best imaging modality for diagnosis. […] Although most patients present with pain, pancreatitis is painless in roughly 10% to 20% of patients. […] The diagnosis of chronic pancreatitis is made based on a patient’s history, clinical presentation, and imaging findings. […] Diagnostic tests should be chosen based on their availability after consideration of risks and benefits. […] A meta-analysis of 43 studies that included more than 3,400 patients concluded that computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography have comparably high diagnostic accuracy for chronic pancreatitis; therefore, a stepwise approach based on cost, invasiveness, and availability is recommended.

• #9 Diagnosing Chronic Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478450/

  Two major classification systems have been established to help assess risk factors in the development of CP: TIGAR-O and MANNHEIM and are helpful in guiding providers as to when to initiate testing for CP. […] Current testing modalities are generally in two categories: Imaging (CT, MRI, EUS, ERCP) and pancreatic function tests (further divided into direct and indirect tests). […] Computed tomography (CT) is considered the best initial imaging test in the workup for CP. […] While CT has seen profound improvements over the last 3 decades, there are significant limitations in diagnosing CP, particularly in evaluation of pancreatic ductal anatomy as well as assisting in diagnosis of early CP. […] Endoscopic Ultrasound (EUS) is another tool that has increasingly been used in the workup of chronic pancreatitis.

• #10 Pancreatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/drc-20360233

  Your healthcare professional will ask you questions about your health history and symptoms, give you a general physical, and check for pain or tenderness in your belly. […] Tests and procedures that may be used include the following. […] Blood tests can give clues about how the immune system, pancreas and related organs are working. […] Ultrasound images can show gallstones in the gallbladder or inflammation of the pancreas. […] Computerized tomography (CT) scan show gallstones and the extent of inflammation. […] Magnetic resonance imaging (MRI) to look for irregular tissues or structures in the gallbladder, pancreas and bile ducts. […] Endoscopic ultrasound is an ultrasound device on a small tube fed through the mouth and into the digestive system. It can show inflammation, gallstones, cancer, and blockages in the pancreatic duct or bile duct.

• #11 Diagnosing Chronic Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478450/

  Two major classification systems have been established to help assess risk factors in the development of CP: TIGAR-O and MANNHEIM and are helpful in guiding providers as to when to initiate testing for CP. […] Current testing modalities are generally in two categories: Imaging (CT, MRI, EUS, ERCP) and pancreatic function tests (further divided into direct and indirect tests). […] Computed tomography (CT) is considered the best initial imaging test in the workup for CP. […] While CT has seen profound improvements over the last 3 decades, there are significant limitations in diagnosing CP, particularly in evaluation of pancreatic ductal anatomy as well as assisting in diagnosis of early CP. […] Endoscopic Ultrasound (EUS) is another tool that has increasingly been used in the workup of chronic pancreatitis.

• #12 Chronic Pancreatitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/181554-overview

  The most predictive endosonographic feature of chronic pancreatitis is the presence of stones. Other suggestive features include the following: Visible side branches, Cysts, Lobularity, An irregular main pancreatic duct, Hyperechoic foci and strands, Dilation of the main pancreatic duct, Hyperechoic margins of the main pancreatic duct. […] Chronic pancreatitis usually is envisioned as an atrophic fibrotic gland with dilated ducts and calcifications. However, the findings on conventional diagnostic studies may be normal in the early stages of chronic pancreatitis, as the inflammatory changes can be seen only by histologic examination. […] The patient with chronic pancreatitis clinically presents with chronic abdominal pain and normal or mildly elevated pancreatic enzyme levels. When the pancreas loses its endocrine and exocrine function, the patient presents with diabetes mellitus and steatorrhea.

• #13 Evaluation and Diagnosis of Chronic Pancreatitis

  https://www.medscape.org/viewarticle/709095

  The classic disease triadpancreatic calcification, diabetes mellitus, and clinically significant malabsorptionemerges only in advanced disease, often accompanied by complications such as pseudocysts, bile duct or duodenal obstruction, ascites, splenic vein thrombosis, or pancreatic cancer, which also require evaluation and management. […] Although there is no single test that is diagnostic for early CP, laboratory testing during painful episodes may be helpful in some patients with acute exacerbation of their CP, since pancreatic enzyme levels are typically elevated more than 3 times the upper limits of normal. […] In chronic pancreatitis, serum concentrations of amylase and lipase may be mildly elevated but are usually normal for the following reasons: (1) significant pancreatic fibrosis frequently reduces the level of these enzymes within the pancreas; and (2) CP tends to be a patchy, focal disease that only minimally increases pancreatic enzymes in the blood.

• #14 Evaluation and Diagnosis of Chronic Pancreatitis

  https://www.medscape.org/viewarticle/709095

  The classic disease triadpancreatic calcification, diabetes mellitus, and clinically significant malabsorptionemerges only in advanced disease, often accompanied by complications such as pseudocysts, bile duct or duodenal obstruction, ascites, splenic vein thrombosis, or pancreatic cancer, which also require evaluation and management. […] Although there is no single test that is diagnostic for early CP, laboratory testing during painful episodes may be helpful in some patients with acute exacerbation of their CP, since pancreatic enzyme levels are typically elevated more than 3 times the upper limits of normal. […] In chronic pancreatitis, serum concentrations of amylase and lipase may be mildly elevated but are usually normal for the following reasons: (1) significant pancreatic fibrosis frequently reduces the level of these enzymes within the pancreas; and (2) CP tends to be a patchy, focal disease that only minimally increases pancreatic enzymes in the blood.

• #15 Pancreatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/drc-20360233

  Your healthcare professional will ask you questions about your health history and symptoms, give you a general physical, and check for pain or tenderness in your belly. […] Tests and procedures that may be used include the following. […] Blood tests can give clues about how the immune system, pancreas and related organs are working. […] Ultrasound images can show gallstones in the gallbladder or inflammation of the pancreas. […] Computerized tomography (CT) scan show gallstones and the extent of inflammation. […] Magnetic resonance imaging (MRI) to look for irregular tissues or structures in the gallbladder, pancreas and bile ducts. […] Endoscopic ultrasound is an ultrasound device on a small tube fed through the mouth and into the digestive system. It can show inflammation, gallstones, cancer, and blockages in the pancreatic duct or bile duct.

• #16 Diagnosis of Pancreatitis – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis/diagnosis

  To diagnose pancreatitis and find its causes, doctors use your medical history, a physical exam, lab and imaging tests. […] Health care professionals may use lab or imaging tests to diagnose pancreatitis and find its causes. Diagnosing chronic pancreatitis can be hard in the early stages. Your doctor will also test for other conditions that have similar symptoms, such as peptic ulcers or pancreatic cancer. […] Lab tests to help diagnose pancreatitis include the following: Blood tests. A health care professional may take a blood sample from you and send the sample to a lab to test for high amylase and lipase levels, high blood glucose, high levels of blood fats, signs of infection or inflammation of the bile ducts, pancreas, gallbladder, or liver, and pancreatic cancer. […] Health care professionals also use imaging tests to diagnose pancreatitis.

• #17 Chronic Pancreatitis – Clinical Features – Investigations – TeachMeSurgery

  https://teachmesurgery.com/hpb/pancreas/chronic-pancreatitis/

  A faecal elastase level will be low in most cases of chronic pancreatitis with exocrine insufficiency, often can aid the diagnosis. […] CT imaging can often show pancreatic atrophy or calcification, as well as any pseudocysts present. […] Chronic pancreatitis can only be managed definitively by treating any reversible underlying cause. […] Management is mainly based around symptom control, optimising analgesia, and nutritional support. […] Reduced faecal elastase and CT imaging can be used to confirm the diagnosis.

• #18 Chronic Pancreatitis Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-pancreatitis/diagnosis.html

  Chronic pancreatitis is classically diagnosed with a tissue specimen that shows evidence of injury. Since gathering tissue to prove the diagnosis is difficult without causing substantial risk, we often try to make the diagnosis of chronic pancreatitis through history, physical exam, imaging, and function tests. […] Common imaging methods we use to make a diagnosis of chronic pancreatitis include: […] In more advanced stages of pancreatitis, when malabsorption and diabetes can occur, we may order blood, urine, and stool tests to help diagnose chronic pancreatitis and monitor its progression. […] These tests, particularly EUS, are considered more sensitive to catch early disease when changes in the pancreas are subtle.

• #19 Pancreatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/drc-20360233

  Stool tests can measure levels of fat that could suggest your digestive system isn’t absorbing nutrients as it should. […] Your doctor may recommend other tests, depending on your symptoms or other conditions you may have. […] Chronic pancreatitis may require additional treatments, including: […] Pain management. Chronic pancreatitis often causes severe, long-term pain. In addition to prescribing medicine, your healthcare professional will look for causes or complications of chronic pancreatitis that cause pain. Treatments may include procedures to improve drainage from the pancreas or injections to block nerve signals from the pancreas to the brain. You may be referred to a pain specialist. […] Enzymes to improve digestion. When chronic pancreatitis causes diarrhea or weight loss, you may take pancreatic enzyme supplements. Taken with each meal, these enzyme supplements help your body break down and use the nutrients in food. […] Changes to your diet. Your doctor may refer you to a dietitian who can help you plan low-fat meals that are high in nutrients.

• #20 Evaluation and Diagnosis of Chronic Pancreatitis

  https://www.medscape.org/viewarticle/709095

  Steatorrhea, if suspected, can be assessed qualitatively by Sudan staining of feces. […] In the proper clinical setting (typical abdominal pain), confirmation of steatorrhea may be sufficient to diagnose CP. […] Pancreatic function tests (PFTs) can be helpful in diagnosing patients who experience recurrent abdominal pain but have normal imaging and laboratory tests. […] The complete blood count and electrolytes are typically normal in the absence of significant vomiting and poor oral intake. […] In about 30% percent of patients with CP, plain abdominal films reveal calcifications within the pancreatic duct. […] Transabdominal ultrasound, CT scan, and magnetic resonance imaging can all assist in diagnosis and management of CP. […] ERCP has been deemed the gold standard imaging procedure for diagnosing CP, with beading of the main pancreatic duct, stones or protein plugs within the duct, and ecstatic side branches considered diagnostic. […] These cases underscore the need for the clinician-historian to look at the patient’s entire life, keeping in mind that it is often more difficult to diagnose CP when alcohol is not a factor.

• #21 Chronic pancreatitis – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/chronic-pancreatitis/

  Chronic pancreatitis is hard to diagnose. This is because it is rare and the symptoms overlap with other more common conditions, such as Irritable Bowel Syndrome (IBS). […] Investigation aims to show abnormalities in the structure of the pancreas and/or how the pancreas works. A specialist gastroenterologist or specialist liver, biliary and pancreas surgeon usually supervises a person’s care. […] Unfortunately, there is no single test for chronic pancreatitis at this time, and many pancreatic cells can be damaged before abnormalities on tests show up. […] Once the damage and scarring advances and becomes more severe the pancreas damage may be detected by blood tests or scans. […] Investigations involve scans, such as CT and MRI scans which give the best pictures of the pancreas. […] The simplest test of the function of the pancreas (how good it is at producing digestive juices) is the faecal elastase test. […] Blood tests to look for vitamin and mineral deficiencies can also support a diagnosis of pancreatic exocrine insufficiency (PEI) and chronic pancreatitis.

• #22 Chronic Pancreatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0315/p385.html

  If chronic pancreatitis is still suspected despite normal imaging findings, pancreatic function tests can be performed. […] The radiologic evaluation of a patient with suspected chronic pancreatitis should progress from least invasive to more invasive. […] If CT findings are equivocal, patients may require referral for more focused pancreatic imaging, such as MRI or magnetic resonance cholangiopancreatography, or for endoscopic procedures, such as EUS or endoscopic retrograde cholangiopancreatography.

• #23 Diagnosing Chronic Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478450/

  Two major classification systems have been established to help assess risk factors in the development of CP: TIGAR-O and MANNHEIM and are helpful in guiding providers as to when to initiate testing for CP. […] Current testing modalities are generally in two categories: Imaging (CT, MRI, EUS, ERCP) and pancreatic function tests (further divided into direct and indirect tests). […] Computed tomography (CT) is considered the best initial imaging test in the workup for CP. […] While CT has seen profound improvements over the last 3 decades, there are significant limitations in diagnosing CP, particularly in evaluation of pancreatic ductal anatomy as well as assisting in diagnosis of early CP. […] Endoscopic Ultrasound (EUS) is another tool that has increasingly been used in the workup of chronic pancreatitis.

• #24 Chronic Pancreatitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/371772-overview

  Endoscopic retrograde cholangiopancreatography (ERCP) provides the most accurate visualization of the pancreatic ductal system and is considered the gold standard for diagnosing chronic pancreatitis. […] EUS is the most sensitive imaging technique for the diagnosis of CP, mainly during the early stages of the disease, and its specificity increases with increasing diagnostic criteria. […] EUS, ERCP, MRI and CT all have comparable high diagnostic accuracy in the initial diagnosis of chronic pancreatitis. […] The clinical practice guidelines for the diagnostic cross-sectional imaging and severity scoring of chronic pancreatitis were released in October 2018 by the Working Group for the International Consensus Guidelines for Chronic Pancreatitis and include the following: Computed tomography (CT) is often the most appropriate initial imaging modality to evaluate suspected chronic pancreatitis (CP); it depicts most of the changes in pancreatic morphology.

• #25 Chronic Pancreatitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/181554-overview

  Chronic pancreatitis is commonly defined as a continuing, chronic, inflammatory process of the pancreas, characterized by irreversible morphologic changes. […] Diagnosis is based on tests of pancreatic structure and function. […] Imaging studies such as abdominal radiography and CT scanning can show inflammation or calcium deposits in the pancreas or changes in the pancreatic ducts. Pancreatic calcifications, often considered pathognomonic of chronic pancreatitis, are observed in approximately 30% of cases. […] The endoscopic retrograde cholangiopancreatography (ERCP) test provides the most accurate visualization of the pancreatic ductal system and has been regarded as the criterion standard for diagnosing chronic pancreatitis. […] MRCP provides information on the pancreatic parenchyma and adjacent abdominal viscera, and it uses heavily T2-weighted images to visualize the biliary and pancreatic ductal systems.

• #26 Chronic pancreatitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/chronic-pancreatitis-2?lang=us

  Acute pancreatitis and chronic pancreatitis are assumed to be different disease processes, and most cases of acute pancreatitis do not result in chronic disease. […] Diagnostic criteria of CT features of chronic pancreatitis are: Moderate pancreatitis (2 of the following): pancreatic enlargement (up to 2x of normal), irregular head or body of pancreas, focal acute pancreatitis, heterogenous parenchyma, small cavities (less than 10 mm), dilatation of the main pancreatic duct (2 to 4 mm), irregular ducts, increased density of main pancreatic ductal wall. Marked pancreatitis (1 of the following): gross enlargement of pancreas (2x of normal size), pancreatic calcification, pancreatic pseudocysts, large cavities (more than 10 mm), filling defects within pancreatic duct or calculus within duct, ductal obstruction, stricture, irregularity.

• #27 Chronic Pancreatitis – Clinical Features – Investigations – TeachMeSurgery

  https://teachmesurgery.com/hpb/pancreas/chronic-pancreatitis/

  A faecal elastase level will be low in most cases of chronic pancreatitis with exocrine insufficiency, often can aid the diagnosis. […] CT imaging can often show pancreatic atrophy or calcification, as well as any pseudocysts present. […] Chronic pancreatitis can only be managed definitively by treating any reversible underlying cause. […] Management is mainly based around symptom control, optimising analgesia, and nutritional support. […] Reduced faecal elastase and CT imaging can be used to confirm the diagnosis.

• #28 Chronic pancreatitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/chronic-pancreatitis-2?lang=us

  Acute pancreatitis and chronic pancreatitis are assumed to be different disease processes, and most cases of acute pancreatitis do not result in chronic disease. […] Diagnostic criteria of CT features of chronic pancreatitis are: Moderate pancreatitis (2 of the following): pancreatic enlargement (up to 2x of normal), irregular head or body of pancreas, focal acute pancreatitis, heterogenous parenchyma, small cavities (less than 10 mm), dilatation of the main pancreatic duct (2 to 4 mm), irregular ducts, increased density of main pancreatic ductal wall. Marked pancreatitis (1 of the following): gross enlargement of pancreas (2x of normal size), pancreatic calcification, pancreatic pseudocysts, large cavities (more than 10 mm), filling defects within pancreatic duct or calculus within duct, ductal obstruction, stricture, irregularity.

• #29 Pancreatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/drc-20360233

  Your healthcare professional will ask you questions about your health history and symptoms, give you a general physical, and check for pain or tenderness in your belly. […] Tests and procedures that may be used include the following. […] Blood tests can give clues about how the immune system, pancreas and related organs are working. […] Ultrasound images can show gallstones in the gallbladder or inflammation of the pancreas. […] Computerized tomography (CT) scan show gallstones and the extent of inflammation. […] Magnetic resonance imaging (MRI) to look for irregular tissues or structures in the gallbladder, pancreas and bile ducts. […] Endoscopic ultrasound is an ultrasound device on a small tube fed through the mouth and into the digestive system. It can show inflammation, gallstones, cancer, and blockages in the pancreatic duct or bile duct.

• #30 Chronic Pancreatitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/371772-overview

  Endoscopic retrograde cholangiopancreatography (ERCP) provides the most accurate visualization of the pancreatic ductal system and is considered the gold standard for diagnosing chronic pancreatitis. […] EUS is the most sensitive imaging technique for the diagnosis of CP, mainly during the early stages of the disease, and its specificity increases with increasing diagnostic criteria. […] EUS, ERCP, MRI and CT all have comparable high diagnostic accuracy in the initial diagnosis of chronic pancreatitis. […] The clinical practice guidelines for the diagnostic cross-sectional imaging and severity scoring of chronic pancreatitis were released in October 2018 by the Working Group for the International Consensus Guidelines for Chronic Pancreatitis and include the following: Computed tomography (CT) is often the most appropriate initial imaging modality to evaluate suspected chronic pancreatitis (CP); it depicts most of the changes in pancreatic morphology.

• #31 Diagnosing Chronic Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478450/

  Two major classification systems have been established to help assess risk factors in the development of CP: TIGAR-O and MANNHEIM and are helpful in guiding providers as to when to initiate testing for CP. […] Current testing modalities are generally in two categories: Imaging (CT, MRI, EUS, ERCP) and pancreatic function tests (further divided into direct and indirect tests). […] Computed tomography (CT) is considered the best initial imaging test in the workup for CP. […] While CT has seen profound improvements over the last 3 decades, there are significant limitations in diagnosing CP, particularly in evaluation of pancreatic ductal anatomy as well as assisting in diagnosis of early CP. […] Endoscopic Ultrasound (EUS) is another tool that has increasingly been used in the workup of chronic pancreatitis.

• #32 Chronic Pancreatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0315/p385.html

  If chronic pancreatitis is still suspected despite normal imaging findings, pancreatic function tests can be performed. […] The radiologic evaluation of a patient with suspected chronic pancreatitis should progress from least invasive to more invasive. […] If CT findings are equivocal, patients may require referral for more focused pancreatic imaging, such as MRI or magnetic resonance cholangiopancreatography, or for endoscopic procedures, such as EUS or endoscopic retrograde cholangiopancreatography.

• #33 Chronic Pancreatitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/pancreatitis/chronic-pancreatitis

  MRI coupled with magnetic resonance cholangiopancreatography (MRCP) is now frequently used for diagnosis and can show masses in the pancreas as well as provide more optimal visualization of ductal changes consistent with chronic pancreatitis. […] Endoscopic retrograde cholangiopancreatography (ERCP) is invasive and rarely used for the diagnosis of chronic pancreatitis. […] The most common pancreatic function tests do not detect mild to moderate exocrine pancreatic insufficiency with adequate accuracy. […] Direct pancreatic function tests are most useful in patients who have an earlier stage of chronic pancreatitis in whom imaging studies are not diagnostic. […] Indirect pancreatic function tests are less accurate in diagnosing earlier stages of chronic pancreatitis.

• #34 Chronic Pancreatitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/chronic-pancreatitis.html

  Endoscopic ultrasound. This test uses a long, thin tube (endoscope) that is put through your mouth and into your stomach and upper intestine. An ultrasound on the scope makes images of the pancreas and gallbladder ducts. […] ERCP. This test uses a long, thin tube (endoscope) that is put into the pancreas drainage area if treatment needs to be done. […] Magnetic resonance cholangiopancreatography. This test makes images using radio waves, a strong magnet, and a computer. In some MRI tests, you will need to have dye injected to show a more detailed image of your pancreas and the ducts of your gallbladder.

• #35 Pancreatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/drc-20360233

  Your healthcare professional will ask you questions about your health history and symptoms, give you a general physical, and check for pain or tenderness in your belly. […] Tests and procedures that may be used include the following. […] Blood tests can give clues about how the immune system, pancreas and related organs are working. […] Ultrasound images can show gallstones in the gallbladder or inflammation of the pancreas. […] Computerized tomography (CT) scan show gallstones and the extent of inflammation. […] Magnetic resonance imaging (MRI) to look for irregular tissues or structures in the gallbladder, pancreas and bile ducts. […] Endoscopic ultrasound is an ultrasound device on a small tube fed through the mouth and into the digestive system. It can show inflammation, gallstones, cancer, and blockages in the pancreatic duct or bile duct.

• #36 Chronic Pancreatitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/pancreatitis/chronic-pancreatitis

  MRI coupled with magnetic resonance cholangiopancreatography (MRCP) is now frequently used for diagnosis and can show masses in the pancreas as well as provide more optimal visualization of ductal changes consistent with chronic pancreatitis. […] Endoscopic retrograde cholangiopancreatography (ERCP) is invasive and rarely used for the diagnosis of chronic pancreatitis. […] The most common pancreatic function tests do not detect mild to moderate exocrine pancreatic insufficiency with adequate accuracy. […] Direct pancreatic function tests are most useful in patients who have an earlier stage of chronic pancreatitis in whom imaging studies are not diagnostic. […] Indirect pancreatic function tests are less accurate in diagnosing earlier stages of chronic pancreatitis.

• #37 Chronic Pancreatitis – Digestive Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/digestive-disorders/pancreatitis/chronic-pancreatitis

  Many doctors now do a special magnetic resonance imaging (MRI) test called magnetic resonance cholangiopancreatography (MRCP). MRCP shows the bile and pancreatic ducts more clearly than does CT. […] Endoscopic retrograde cholangiopancreatography (ERCP) allows doctors to view the bile duct and pancreatic duct. This test is rarely used for the diagnosis of chronic pancreatitis, but doctors may do it if a certain treatment for the pancreatic duct is needed, such as placing a tube (stent) through a blockage or removing a stone in the duct. […] For chronic pancreatitis, doctors may also do tests of the pancreas to see how it is functioning. These tests help doctors determine whether there is pancreatic insufficiency that can cause malabsorption. […] Blood tests are less useful in diagnosing chronic pancreatitis than in diagnosing acute pancreatitis, but they may indicate elevated levels of amylase and lipase (2 enzymes produced by the pancreas).

• #38 Chronic pancreatitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/chronic-pancreatitis-2?lang=us

  The exocrine function may be assessed by secretin-enhanced magnetic resonance cholangiopancreatography, SMRCP (a.k.a. MRCP-S). This relatively new technique has shown promising results and may replace endoscopic measuring techniques in the near future. […] Standardized reporting terminology has been suggested for chronic pancreatitis. The most used classification is the Cambridge classification, based on the status of the main pancreatic duct (PD) and the presence of side branches abnormalities. […] Pancreatic enzyme replacement therapy (PERT) has been recommended when there are clinical symptoms or laboratory signs of malabsorption. In those patients with refractory pain, in the presence of a dilated main pancreatic duct, endoscopic treatment should be considered, and surgery usually reserved as a second option.

• #39 Chronic pancreatitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/67

  Chronic pancreatitis is most commonly associated with chronic alcohol ingestion (75%). […] Diagnosis is based on clinical findings and imaging. […] Key diagnostic factors include presence of risk factors, abdominal pain, steatorrhoea, and jaundice. […] 1st investigations to order include computed tomography (CT) or magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS), and secretin-enhanced magnetic resonance cholangiopancreatography (s-MRCP). […] Investigations to consider include histological examination, genetic testing, indirect pancreatic function test (faecal elastase-1), faecal fat, steatocrit, direct pancreatic function tests, IgG4 levels, and therapeutic trial of corticosteroids.

• #40

  https://link.springer.com/article/10.1007/s40265-020-01360-6

  Chronic pancreatitis is a clinical entity that results from the progressive inflammation and irreversible fibrosis of the pancreas resulting from the cumulative injury sustained by the pancreas over time. […] The diagnosis of chronic pancreatitis can be challenging as despite the recent advancements in imaging technology, the radiographic findings do not become prominent until late stages of disease. […] Thus, the physicians clinical acumen in obtaining thorough history taking focusing on risk factors, clinical symptoms, in addition to high-quality imaging, often guide to the accurate diagnosis of chronic pancreatitis. […] Endoscopic ultrasound (EUS) is believed to be the most sensitive modality for diagnosing chronic pancreatitis. […] Recent advancements in genomic studies have furthered our understanding of the genetic polymorphisms that are associated with the pathogenesis of chronic pancreatitis.

• #41 Chronic Pancreatitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/371772-overview

  Endoscopic retrograde cholangiopancreatography (ERCP) provides the most accurate visualization of the pancreatic ductal system and is considered the gold standard for diagnosing chronic pancreatitis. […] EUS is the most sensitive imaging technique for the diagnosis of CP, mainly during the early stages of the disease, and its specificity increases with increasing diagnostic criteria. […] EUS, ERCP, MRI and CT all have comparable high diagnostic accuracy in the initial diagnosis of chronic pancreatitis. […] The clinical practice guidelines for the diagnostic cross-sectional imaging and severity scoring of chronic pancreatitis were released in October 2018 by the Working Group for the International Consensus Guidelines for Chronic Pancreatitis and include the following: Computed tomography (CT) is often the most appropriate initial imaging modality to evaluate suspected chronic pancreatitis (CP); it depicts most of the changes in pancreatic morphology.

• #42 Diagnosing Chronic Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478450/

  Two major classification systems have been established to help assess risk factors in the development of CP: TIGAR-O and MANNHEIM and are helpful in guiding providers as to when to initiate testing for CP. […] Current testing modalities are generally in two categories: Imaging (CT, MRI, EUS, ERCP) and pancreatic function tests (further divided into direct and indirect tests). […] Computed tomography (CT) is considered the best initial imaging test in the workup for CP. […] While CT has seen profound improvements over the last 3 decades, there are significant limitations in diagnosing CP, particularly in evaluation of pancreatic ductal anatomy as well as assisting in diagnosis of early CP. […] Endoscopic Ultrasound (EUS) is another tool that has increasingly been used in the workup of chronic pancreatitis.

• #43 Chronic Pancreatitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/181554-overview

  The most predictive endosonographic feature of chronic pancreatitis is the presence of stones. Other suggestive features include the following: Visible side branches, Cysts, Lobularity, An irregular main pancreatic duct, Hyperechoic foci and strands, Dilation of the main pancreatic duct, Hyperechoic margins of the main pancreatic duct. […] Chronic pancreatitis usually is envisioned as an atrophic fibrotic gland with dilated ducts and calcifications. However, the findings on conventional diagnostic studies may be normal in the early stages of chronic pancreatitis, as the inflammatory changes can be seen only by histologic examination. […] The patient with chronic pancreatitis clinically presents with chronic abdominal pain and normal or mildly elevated pancreatic enzyme levels. When the pancreas loses its endocrine and exocrine function, the patient presents with diabetes mellitus and steatorrhea.

• #44 Chronic Pancreatitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/181554-overview

  The most predictive endosonographic feature of chronic pancreatitis is the presence of stones. Other suggestive features include the following: Visible side branches, Cysts, Lobularity, An irregular main pancreatic duct, Hyperechoic foci and strands, Dilation of the main pancreatic duct, Hyperechoic margins of the main pancreatic duct. […] Chronic pancreatitis usually is envisioned as an atrophic fibrotic gland with dilated ducts and calcifications. However, the findings on conventional diagnostic studies may be normal in the early stages of chronic pancreatitis, as the inflammatory changes can be seen only by histologic examination. […] The patient with chronic pancreatitis clinically presents with chronic abdominal pain and normal or mildly elevated pancreatic enzyme levels. When the pancreas loses its endocrine and exocrine function, the patient presents with diabetes mellitus and steatorrhea.

• #45 Chronic Pancreatitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/181554-overview

  The most predictive endosonographic feature of chronic pancreatitis is the presence of stones. Other suggestive features include the following: Visible side branches, Cysts, Lobularity, An irregular main pancreatic duct, Hyperechoic foci and strands, Dilation of the main pancreatic duct, Hyperechoic margins of the main pancreatic duct. […] Chronic pancreatitis usually is envisioned as an atrophic fibrotic gland with dilated ducts and calcifications. However, the findings on conventional diagnostic studies may be normal in the early stages of chronic pancreatitis, as the inflammatory changes can be seen only by histologic examination. […] The patient with chronic pancreatitis clinically presents with chronic abdominal pain and normal or mildly elevated pancreatic enzyme levels. When the pancreas loses its endocrine and exocrine function, the patient presents with diabetes mellitus and steatorrhea.

• #46 Endosonographic Criteria Chronic Pancreatitis – Endoscopy Campus

  https://www.endoscopy-campus.com/en/classifications/endosonographic-criteria-chronic-pancreatitis-1/

  On EUS, the diagnosis of chronic pancreatitis is based on assessment of the duct and also the parenchyma. The nine classic criteria listed in Table 1 can be diagnosed. Intraparenchymal calcifications and pancreatic duct stones are highly specific criteria. In the absence of these types of pathology, only the simultaneous occurrence of four or more of the other criteria is consistent with chronic pancreatitis. If only two or fewer criteria are present, chronic pancreatitis is unlikely. When a diagnosis of chronic pancreatitis is established using EUS, it is particularly important for the report on the findings to document each criterion tested, in order to substantiate that a complete examination has been carried out. […] The Rosemont classification is another system that is used to diagnose chronic pancreatitis with EUS. Despite this weighting of the criteria, however, no benefit in comparison with the classic criteria has yet been demonstrated. The above systems make it possible to assess the likelihood that chronic pancreatitis is present, but do not allow any assessment of the severity of the disease. The Cambridge classification, initially developed using endoscopic retrograde cholangiopancreatography (ERCP), is used to assess severity. The EUS criteria used here are almost identical with the classic criteria. However, the ductal and parenchymal changes are not viewed separately from one another, and instead it is the combination of pathologies that is used to assess the degree of severity.

• #47 Endoscopic ultrasound in the diagnosis of chronic pancreatitis

  http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015000400006

  EUS has the ability to produce high-resolution ultrasonography images of the pancreas due to the proximity of the transducer to the gland, avoiding interference by air in the intestine. EUS diagnosis of CP is based on specific criteria that have been described by the International Working Group for Minimum Standard Terminology in Gastrointestinal Endoscopy. […] The number of criteria that is needed to establish the diagnosis of CP and the relative weight of each criterion has been a matter of debate for several years. […] One of the most important weaknesses of EUS in the diagnosis of CP is concern about poor interobserver agreement. […] The use of radial or linear echoendoscopes does not have a significant impact on inter observer agreement. […] A combined use of endoscopic function test and EUS has recently been brought forward as a sensitive and accurate method for early diagnosis of CP.

• #48 Endosonographic Criteria Chronic Pancreatitis – Endoscopy Campus

  https://www.endoscopy-campus.com/en/classifications/endosonographic-criteria-chronic-pancreatitis-1/

  On EUS, the diagnosis of chronic pancreatitis is based on assessment of the duct and also the parenchyma. The nine classic criteria listed in Table 1 can be diagnosed. Intraparenchymal calcifications and pancreatic duct stones are highly specific criteria. In the absence of these types of pathology, only the simultaneous occurrence of four or more of the other criteria is consistent with chronic pancreatitis. If only two or fewer criteria are present, chronic pancreatitis is unlikely. When a diagnosis of chronic pancreatitis is established using EUS, it is particularly important for the report on the findings to document each criterion tested, in order to substantiate that a complete examination has been carried out. […] The Rosemont classification is another system that is used to diagnose chronic pancreatitis with EUS. Despite this weighting of the criteria, however, no benefit in comparison with the classic criteria has yet been demonstrated. The above systems make it possible to assess the likelihood that chronic pancreatitis is present, but do not allow any assessment of the severity of the disease. The Cambridge classification, initially developed using endoscopic retrograde cholangiopancreatography (ERCP), is used to assess severity. The EUS criteria used here are almost identical with the classic criteria. However, the ductal and parenchymal changes are not viewed separately from one another, and instead it is the combination of pathologies that is used to assess the degree of severity.

• #49 Diagnosing Chronic Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478450/

  Endoscopic retrograde cholangiopancreatography (ERCP) is a modality seldom used for diagnosis of CP at the present time. […] Pancreatic Function Tests (PFTs) are typically classified as indirect (noninvasive) or direct (invasive). […] Direct PFTs and EUS may have the greatest benefit in helping to diagnose early CP. […] In summary, diagnosing CP can range from routine in those with severe disease and obvious calcifications on CT imaging to elusive in those patients with early changes of CP.

• #50 Chronic pancreatitis: Negotiating the complexities of diagnosis and management

  https://www.racgp.org.au/afp/2015/october/chronic-pancreatitis-negotiating-the-complexities

  Chronic pancreatitis is a slow, irreversible process characterised by pancreatic parenchymal loss, fibrosis and possible calculus formation. Its principal aetiological factor in Western countries is the consumption of alcohol. […] Chronic pancreatitis, first and foremost, presents a diagnostic dilemma. If defined in strictly histological terms (as above), the gold standard test would be a pancreatic biopsy; but this is not feasible or safe for diagnostic work-up in clinical practice. The radiological gold standard diagnostic test has been endoscopic retrograde cholangiopancreatography (ERCP), but this can no longer be justified for purely diagnostic purposes because of potential risks. […] None of the above morphological or functional diagnostic tests is completely sensitive (early symptomatic cases may not be detected) or specific (test-positive cases without symptoms may not warrant active management). In clinical practice, therefore, a composite diagnosis based on clinical, morphological and functional criteria is more pragmatic.

• #51 Chronic Pancreatitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/181554-overview

  Chronic pancreatitis is commonly defined as a continuing, chronic, inflammatory process of the pancreas, characterized by irreversible morphologic changes. […] Diagnosis is based on tests of pancreatic structure and function. […] Imaging studies such as abdominal radiography and CT scanning can show inflammation or calcium deposits in the pancreas or changes in the pancreatic ducts. Pancreatic calcifications, often considered pathognomonic of chronic pancreatitis, are observed in approximately 30% of cases. […] The endoscopic retrograde cholangiopancreatography (ERCP) test provides the most accurate visualization of the pancreatic ductal system and has been regarded as the criterion standard for diagnosing chronic pancreatitis. […] MRCP provides information on the pancreatic parenchyma and adjacent abdominal viscera, and it uses heavily T2-weighted images to visualize the biliary and pancreatic ductal systems.

• #52 Chronic Pancreatitis – Digestive Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/digestive-disorders/pancreatitis/chronic-pancreatitis

  Many doctors now do a special magnetic resonance imaging (MRI) test called magnetic resonance cholangiopancreatography (MRCP). MRCP shows the bile and pancreatic ducts more clearly than does CT. […] Endoscopic retrograde cholangiopancreatography (ERCP) allows doctors to view the bile duct and pancreatic duct. This test is rarely used for the diagnosis of chronic pancreatitis, but doctors may do it if a certain treatment for the pancreatic duct is needed, such as placing a tube (stent) through a blockage or removing a stone in the duct. […] For chronic pancreatitis, doctors may also do tests of the pancreas to see how it is functioning. These tests help doctors determine whether there is pancreatic insufficiency that can cause malabsorption. […] Blood tests are less useful in diagnosing chronic pancreatitis than in diagnosing acute pancreatitis, but they may indicate elevated levels of amylase and lipase (2 enzymes produced by the pancreas).

• #53 Chronic Pancreatitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/chronic-pancreatitis.html

  Endoscopic ultrasound. This test uses a long, thin tube (endoscope) that is put through your mouth and into your stomach and upper intestine. An ultrasound on the scope makes images of the pancreas and gallbladder ducts. […] ERCP. This test uses a long, thin tube (endoscope) that is put into the pancreas drainage area if treatment needs to be done. […] Magnetic resonance cholangiopancreatography. This test makes images using radio waves, a strong magnet, and a computer. In some MRI tests, you will need to have dye injected to show a more detailed image of your pancreas and the ducts of your gallbladder.

• #54 Diagnosing Chronic Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478450/

  Endoscopic retrograde cholangiopancreatography (ERCP) is a modality seldom used for diagnosis of CP at the present time. […] Pancreatic Function Tests (PFTs) are typically classified as indirect (noninvasive) or direct (invasive). […] Direct PFTs and EUS may have the greatest benefit in helping to diagnose early CP. […] In summary, diagnosing CP can range from routine in those with severe disease and obvious calcifications on CT imaging to elusive in those patients with early changes of CP.

• #55 Chronic Pancreatitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/pancreatitis/chronic-pancreatitis

  MRI coupled with magnetic resonance cholangiopancreatography (MRCP) is now frequently used for diagnosis and can show masses in the pancreas as well as provide more optimal visualization of ductal changes consistent with chronic pancreatitis. […] Endoscopic retrograde cholangiopancreatography (ERCP) is invasive and rarely used for the diagnosis of chronic pancreatitis. […] The most common pancreatic function tests do not detect mild to moderate exocrine pancreatic insufficiency with adequate accuracy. […] Direct pancreatic function tests are most useful in patients who have an earlier stage of chronic pancreatitis in whom imaging studies are not diagnostic. […] Indirect pancreatic function tests are less accurate in diagnosing earlier stages of chronic pancreatitis.

• #56 Diagnosis of Pancreatitis – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis/diagnosis

  Ultrasound uses a device called a transducer, which bounces safe, painless sound waves off your organs to create a picture of their structure. […] CT scans create pictures of your pancreas, gallbladder, and bile ducts. CT scans can show pancreatitis or pancreatic cancer. […] MRCP uses a magnetic resonance imaging (MRI) machine, which creates pictures of your organs and soft tissues without x-rays. Your doctor or a specialist may use MRCP to look at your pancreas, gallbladder, and bile ducts for causes of pancreatitis. […] Your doctor may use this test to measure how your pancreas responds to secretin, a hormone made by the small intestine.

• #57 Uncommon Test Helps Confirm Chronic Pancreatitis Diagnosis | Duke Health Referring Physicians

  https://physicians.dukehealth.org/articles/uncommon-test-helps-confirm-chronic-pancreatitis-diagnosis

  Chronic pancreatitis can mimic peptic ulcer disease, gastritis, and other gastrointestinal conditions, making it difficult to diagnose. However, an endoscopic pancreatic function test that Duke is one of only a few medical centers in the country to offer can help to better identify the indolent inflammatory condition. […] Typically, the inflammatory condition is diagnosed when patients present with abdominal pain and have some form of imaging. However, even after a CT scan, MRI, and endoscopic ultrasound, the findings may not confirm a diagnosis. […] The most sensitive test for the diagnosis of chronic pancreatitis is the secretin pancreatic function test. […] Kothari explains that if the peak bicarbonate is below the 80 mEq threshold, it indicates a diagnosis of chronic pancreatitis; importantly, though, a normal test has a 97% negative predicted value, virtually ruling out chronic pancreatitis.

• #58 Caring for Patients With Chronic Pancreatitis

  https://www.uspharmacist.com/article/caring-for-patients-with-chronic-pancreatitis

  Chronic pancreatitis is a progressive condition of the pancreas characterized by long-standing inflammation, abdominal pain, and loss of endocrine and exocrine function. […] Diagnosis of chronic pancreatitis usually involves analyzing a patients signs and symptoms, as well as visualization of the pancreas by MRI, CT, or both. Endoscopic ultrasound is another method used to diagnose chronic pancreatitis. […] Additionally, pancreatic function tests such as secretin or cholecystokinin stimulation can be used when imaging results are ambiguous. […] Limited data are available comparing conservative therapy (i.e., dietary and lifestyle modifications) with more invasive therapy (i.e., surgical or endoscopic interventions). Therefore, treatment plans and decisions should be individualized and made in conjunction with patients based on disease severity and patient-specific analysis of risk versus benefit.

• #59 Chronic Pancreatitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/pancreatitis/chronic-pancreatitis

  MRI coupled with magnetic resonance cholangiopancreatography (MRCP) is now frequently used for diagnosis and can show masses in the pancreas as well as provide more optimal visualization of ductal changes consistent with chronic pancreatitis. […] Endoscopic retrograde cholangiopancreatography (ERCP) is invasive and rarely used for the diagnosis of chronic pancreatitis. […] The most common pancreatic function tests do not detect mild to moderate exocrine pancreatic insufficiency with adequate accuracy. […] Direct pancreatic function tests are most useful in patients who have an earlier stage of chronic pancreatitis in whom imaging studies are not diagnostic. […] Indirect pancreatic function tests are less accurate in diagnosing earlier stages of chronic pancreatitis.

• #60 Uncommon Test Helps Confirm Chronic Pancreatitis Diagnosis | Duke Health Referring Physicians

  https://physicians.dukehealth.org/articles/uncommon-test-helps-confirm-chronic-pancreatitis-diagnosis

  Chronic pancreatitis can mimic peptic ulcer disease, gastritis, and other gastrointestinal conditions, making it difficult to diagnose. However, an endoscopic pancreatic function test that Duke is one of only a few medical centers in the country to offer can help to better identify the indolent inflammatory condition. […] Typically, the inflammatory condition is diagnosed when patients present with abdominal pain and have some form of imaging. However, even after a CT scan, MRI, and endoscopic ultrasound, the findings may not confirm a diagnosis. […] The most sensitive test for the diagnosis of chronic pancreatitis is the secretin pancreatic function test. […] Kothari explains that if the peak bicarbonate is below the 80 mEq threshold, it indicates a diagnosis of chronic pancreatitis; importantly, though, a normal test has a 97% negative predicted value, virtually ruling out chronic pancreatitis.

• #61 Chronic Pancreatitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/pancreatitis/chronic-pancreatitis

  MRI coupled with magnetic resonance cholangiopancreatography (MRCP) is now frequently used for diagnosis and can show masses in the pancreas as well as provide more optimal visualization of ductal changes consistent with chronic pancreatitis. […] Endoscopic retrograde cholangiopancreatography (ERCP) is invasive and rarely used for the diagnosis of chronic pancreatitis. […] The most common pancreatic function tests do not detect mild to moderate exocrine pancreatic insufficiency with adequate accuracy. […] Direct pancreatic function tests are most useful in patients who have an earlier stage of chronic pancreatitis in whom imaging studies are not diagnostic. […] Indirect pancreatic function tests are less accurate in diagnosing earlier stages of chronic pancreatitis.

• #62 Chronic pancreatitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/67

  Chronic pancreatitis is most commonly associated with chronic alcohol ingestion (75%). […] Diagnosis is based on clinical findings and imaging. […] Key diagnostic factors include presence of risk factors, abdominal pain, steatorrhoea, and jaundice. […] 1st investigations to order include computed tomography (CT) or magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS), and secretin-enhanced magnetic resonance cholangiopancreatography (s-MRCP). […] Investigations to consider include histological examination, genetic testing, indirect pancreatic function test (faecal elastase-1), faecal fat, steatocrit, direct pancreatic function tests, IgG4 levels, and therapeutic trial of corticosteroids.

• #63 Pancreatitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/8103-pancreatitis

  Chronic pancreatitis is a long-term, progressive condition. It doesn’t go away and gets worse over time. It happens when the injury or damage to your pancreas never stops. Chronic pancreatitis will eventually do lasting damage to your pancreas, although it may take many years. Constant inflammation causes scarring of your pancreas tissues (fibrosis), which stops them from making enzymes and hormones. […] If your provider suspects you have chronic pancreatitis, they may order additional tests, including: Glucose test (to see whether your pancreas is still producing insulin effectively). Stool elastase test (to see if your pancreas is making enough digestive enzymes). Fecal fat analysis (to test for excess fat in your poop, a sign of fat malabsorption). Blood tests (to assess your nutritional status and whether you have enough fat-soluble vitamins in your blood).

• #64 Patient education: Chronic pancreatitis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-pancreatitis-beyond-the-basics/print

  Chronic pancreatitis can lead to a variety of complications, including the following (see „Overview of the complications of chronic pancreatitis”): […] It can be difficult to diagnose chronic pancreatitis; the signs and symptoms can be similar to those caused by other health problems, such as an ulcer, gallstones, irritable bowel syndrome, or even pancreatic cancer. […] Blood tests can detect digestive enzymes that leak out of the pancreas into the bloodstream when the pancreas is inflamed. […] Stool tests can detect abnormal levels of fat in a stool sample or low levels of the pancreatic enzyme elastase. […] Imaging tests such as x-ray, ultrasound, CT scan, or MRI provide information about the structure of the pancreas, the ducts that drain the pancreas and gallbladder, and the tissues surrounding the pancreas. […] Some of the tests for chronic pancreatitis can help to determine the likelihood of having pancreatic cancer.

• #65 Caring for Patients With Chronic Pancreatitis

  https://www.uspharmacist.com/article/caring-for-patients-with-chronic-pancreatitis

  Chronic pancreatitis is a progressive condition of the pancreas characterized by long-standing inflammation, abdominal pain, and loss of endocrine and exocrine function. […] Diagnosis of chronic pancreatitis usually involves analyzing a patients signs and symptoms, as well as visualization of the pancreas by MRI, CT, or both. Endoscopic ultrasound is another method used to diagnose chronic pancreatitis. […] Additionally, pancreatic function tests such as secretin or cholecystokinin stimulation can be used when imaging results are ambiguous. […] Limited data are available comparing conservative therapy (i.e., dietary and lifestyle modifications) with more invasive therapy (i.e., surgical or endoscopic interventions). Therefore, treatment plans and decisions should be individualized and made in conjunction with patients based on disease severity and patient-specific analysis of risk versus benefit.

• #66 Chronic Pancreatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0315/p385.html

  Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis, and scarring. […] If chronic pancreatitis is suspected, contrast-enhanced computed tomography is the best imaging modality for diagnosis. […] Although most patients present with pain, pancreatitis is painless in roughly 10% to 20% of patients. […] The diagnosis of chronic pancreatitis is made based on a patient’s history, clinical presentation, and imaging findings. […] Diagnostic tests should be chosen based on their availability after consideration of risks and benefits. […] A meta-analysis of 43 studies that included more than 3,400 patients concluded that computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography have comparably high diagnostic accuracy for chronic pancreatitis; therefore, a stepwise approach based on cost, invasiveness, and availability is recommended.

• #67 Pancreatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/drc-20360233

  Your healthcare professional will ask you questions about your health history and symptoms, give you a general physical, and check for pain or tenderness in your belly. […] Tests and procedures that may be used include the following. […] Blood tests can give clues about how the immune system, pancreas and related organs are working. […] Ultrasound images can show gallstones in the gallbladder or inflammation of the pancreas. […] Computerized tomography (CT) scan show gallstones and the extent of inflammation. […] Magnetic resonance imaging (MRI) to look for irregular tissues or structures in the gallbladder, pancreas and bile ducts. […] Endoscopic ultrasound is an ultrasound device on a small tube fed through the mouth and into the digestive system. It can show inflammation, gallstones, cancer, and blockages in the pancreatic duct or bile duct.

• #68 Chronic Pancreatitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/chronic-pancreatitis.html

  Your healthcare provider will diagnose you with chronic pancreatitis if: […] Your healthcare provider will examine your belly. You will also be asked about your drinking history and any family history of pancreatic disease or cystic fibrosis. Blood and imaging tests are an important part of your diagnosis. They can include: […] Blood tests. They will look for high levels of two pancreatic enzymes, amylase and lipase. These may spill into your blood. Other tests may show blockage or damage of your gallbladder. They can also be used to check for certain inherited conditions. You may need vitamin levels and other lab tests. […] CT scan. This test creates a 3-D image of your pancreas, using X-rays and a computer. […] Abdominal ultrasound. This test uses sound waves to create an image of your pancreas.

• #69 Diagnosis of Pancreatitis – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis/diagnosis

  To diagnose pancreatitis and find its causes, doctors use your medical history, a physical exam, lab and imaging tests. […] Health care professionals may use lab or imaging tests to diagnose pancreatitis and find its causes. Diagnosing chronic pancreatitis can be hard in the early stages. Your doctor will also test for other conditions that have similar symptoms, such as peptic ulcers or pancreatic cancer. […] Lab tests to help diagnose pancreatitis include the following: Blood tests. A health care professional may take a blood sample from you and send the sample to a lab to test for high amylase and lipase levels, high blood glucose, high levels of blood fats, signs of infection or inflammation of the bile ducts, pancreas, gallbladder, or liver, and pancreatic cancer. […] Health care professionals also use imaging tests to diagnose pancreatitis.

• #70 Chronic Pancreatitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/371772-overview

  Endoscopic retrograde cholangiopancreatography (ERCP) provides the most accurate visualization of the pancreatic ductal system and is considered the gold standard for diagnosing chronic pancreatitis. […] EUS is the most sensitive imaging technique for the diagnosis of CP, mainly during the early stages of the disease, and its specificity increases with increasing diagnostic criteria. […] EUS, ERCP, MRI and CT all have comparable high diagnostic accuracy in the initial diagnosis of chronic pancreatitis. […] The clinical practice guidelines for the diagnostic cross-sectional imaging and severity scoring of chronic pancreatitis were released in October 2018 by the Working Group for the International Consensus Guidelines for Chronic Pancreatitis and include the following: Computed tomography (CT) is often the most appropriate initial imaging modality to evaluate suspected chronic pancreatitis (CP); it depicts most of the changes in pancreatic morphology.

• #71 Chronic Pancreatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1201/p1679.html

  Chronic pancreatitis is the progressive and permanent destruction of the pancreas resulting in exocrine and endocrine insufficiency and, often, chronic disabling pain. […] Contrast-enhanced computed tomography is the radiographic test of choice for diagnosis, with ductal calcifications being pathognomonic. […] The diagnosis of chronic pancreatitis is made based on the clinical presentation and imaging studies, especially in advanced disease. However, no single test is diagnostic for early chronic pancreatitis, and each test should be used based on availability and the risks and benefits to the patient. […] Although endoscopic retrograde cholangiopancreatography (ERCP) is still used as the reference standard in studies, contrast-enhanced CT of the abdomen is the initial imaging modality of choice.

• #72 Chronic Pancreatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0315/p385.html

  If chronic pancreatitis is still suspected despite normal imaging findings, pancreatic function tests can be performed. […] The radiologic evaluation of a patient with suspected chronic pancreatitis should progress from least invasive to more invasive. […] If CT findings are equivocal, patients may require referral for more focused pancreatic imaging, such as MRI or magnetic resonance cholangiopancreatography, or for endoscopic procedures, such as EUS or endoscopic retrograde cholangiopancreatography.

• #73

  https://step2.medbullets.com/evidence/31860051

  Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas with a prevalence of 42 to 73 per 100000 adults in the United States. […] The diagnosis is based on pancreatic calcifications, ductal dilatation, and atrophy visualized by imaging with computed tomography, magnetic resonance imaging, or both. Endoscopic ultrasound can assist in making the diagnosis in patients with a high index of suspicion such as recurrent episodes of acute pancreatitis when imaging is normal or equivocal. […] Chronic pancreatitis often results in chronic abdominal pain and is most commonly caused by excessive alcohol use, smoking, or genetic mutations. Treatment consists primarily of alcohol and smoking cessation, pain control, replacement of pancreatic insufficiency, or mechanical drainage of obstructed pancreatic ducts for some patients.

• #74 Chronic Pancreatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1201/p1679.html

  For evaluation of the pancreatic parenchyma and duct system, magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) provide diagnostic performance similar to ERCP. […] EUS with fine-needle aspiration biopsy (FNAB) and pancreatic function tests can be performed in patients with suspected early chronic pancreatitis. […] The accuracy of diagnostic tests is summarized in Table 4. […] One suggested approach to the diagnosis of chronic pancreatitis is shown in Figure 2. […] CT can identify most cases of large duct disease (pancreatic duct dilatation of 7 mm or more) and is the initial diagnostic test of choice. […] EUS alone may overestimate disease because many of the early endoscopic changes with chronic pancreatitis can be identified in normal aging.

• #75 Chronic Pancreatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0315/p385.html

  Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis, and scarring. […] If chronic pancreatitis is suspected, contrast-enhanced computed tomography is the best imaging modality for diagnosis. […] Although most patients present with pain, pancreatitis is painless in roughly 10% to 20% of patients. […] The diagnosis of chronic pancreatitis is made based on a patient’s history, clinical presentation, and imaging findings. […] Diagnostic tests should be chosen based on their availability after consideration of risks and benefits. […] A meta-analysis of 43 studies that included more than 3,400 patients concluded that computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography have comparably high diagnostic accuracy for chronic pancreatitis; therefore, a stepwise approach based on cost, invasiveness, and availability is recommended.

• #76 Patient education: Chronic pancreatitis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-pancreatitis-beyond-the-basics/print

  Chronic pancreatitis can lead to a variety of complications, including the following (see „Overview of the complications of chronic pancreatitis”): […] It can be difficult to diagnose chronic pancreatitis; the signs and symptoms can be similar to those caused by other health problems, such as an ulcer, gallstones, irritable bowel syndrome, or even pancreatic cancer. […] Blood tests can detect digestive enzymes that leak out of the pancreas into the bloodstream when the pancreas is inflamed. […] Stool tests can detect abnormal levels of fat in a stool sample or low levels of the pancreatic enzyme elastase. […] Imaging tests such as x-ray, ultrasound, CT scan, or MRI provide information about the structure of the pancreas, the ducts that drain the pancreas and gallbladder, and the tissues surrounding the pancreas. […] Some of the tests for chronic pancreatitis can help to determine the likelihood of having pancreatic cancer.

• #77 Chronic pancreatitis – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/chronic-pancreatitis/

  Chronic pancreatitis is hard to diagnose. This is because it is rare and the symptoms overlap with other more common conditions, such as Irritable Bowel Syndrome (IBS). […] Investigation aims to show abnormalities in the structure of the pancreas and/or how the pancreas works. A specialist gastroenterologist or specialist liver, biliary and pancreas surgeon usually supervises a person’s care. […] Unfortunately, there is no single test for chronic pancreatitis at this time, and many pancreatic cells can be damaged before abnormalities on tests show up. […] Once the damage and scarring advances and becomes more severe the pancreas damage may be detected by blood tests or scans. […] Investigations involve scans, such as CT and MRI scans which give the best pictures of the pancreas. […] The simplest test of the function of the pancreas (how good it is at producing digestive juices) is the faecal elastase test. […] Blood tests to look for vitamin and mineral deficiencies can also support a diagnosis of pancreatic exocrine insufficiency (PEI) and chronic pancreatitis.

• #78 Chronic pancreatitis: A diagnostic dilemma

  https://www.wjgnet.com/1007-9327/full/v22/i7/2304.htm

  Chronic pancreatitis presents a diagnostic challenge, especially in early disease. This paper summarizes the available diagnostic modalities as well as the most recently-published diagnostic guidelines. […] Typical clinical symptoms of chronic pancreatitis are vague and non-specific and therefore diagnostic tests are required, none of which provide absolute diagnostic certainly, especially in the early stages of disease. Recently-published guidelines bring much needed structure to the diagnostic work-up of patients with suspected chronic pancreatitis. […] Although chronic pancreatitis diagnosis may be suspected following presentation with suggestive symptoms, clinical presentation is usually insufficient for a firm diagnosis. In fact, a diagnosis of chronic pancreatitis is difficult to establish, especially in the early stages of disease. Typical symptoms such as weight loss, pain, steatorrhea, and malnutrition are vague and not specific to chronic pancreatitis. Therefore diagnostic tests of pancreatic structure and function are required – none of which provide absolute diagnostic certainly in the early stages.

• #79 Clinical and laboratory diagnosis of chronic pancreatitis | Pancreapedia

  https://pancreapedia.org/reviews/clinical-and-laboratory-diagnosis-of-chronic-pancreatitis

  Chronic pancreatitis (CP) is still far to rarely diagnosed as symptoms are non-specific and training of physicians in clinical pancreatology is dire (26). With an incidence of 3-4/100,000 inhabitants and a prevalence of 10-40/100,000 inhabitants, CP is a relatively common disease in industrialized countries (16). This chapter aims to cover the essentials of diagnosing chronic pancreatitis and, at the same time, points to open issues for clinical research. […] The clinical picture of CP can vary, depending on the underlying etiology, the stage of disease and the age of the patient (5). The typical clinical picture of CP is that of a patient who, after years of alcohol abuse and smoking and a history of recurrent abdominal pain develops steatorrhea and general malnutrition. Together with weight loss and bloating, these are the four cardinal symptoms of chronic pancreatitis and pancreatic exocrine insufficiency. In summary, there is no single symptom pathognomonic to chronic pancreatitis, i.e. the diagnosis cannot be established solely on the basis of clinical symptoms. However, in the said enigmatic patient, the clinical diagnosis is still very likely.

• #80 Evaluation and Diagnosis of Chronic Pancreatitis

  https://www.medscape.org/viewarticle/709095

  The classic disease triadpancreatic calcification, diabetes mellitus, and clinically significant malabsorptionemerges only in advanced disease, often accompanied by complications such as pseudocysts, bile duct or duodenal obstruction, ascites, splenic vein thrombosis, or pancreatic cancer, which also require evaluation and management. […] Although there is no single test that is diagnostic for early CP, laboratory testing during painful episodes may be helpful in some patients with acute exacerbation of their CP, since pancreatic enzyme levels are typically elevated more than 3 times the upper limits of normal. […] In chronic pancreatitis, serum concentrations of amylase and lipase may be mildly elevated but are usually normal for the following reasons: (1) significant pancreatic fibrosis frequently reduces the level of these enzymes within the pancreas; and (2) CP tends to be a patchy, focal disease that only minimally increases pancreatic enzymes in the blood.

• #81 Chronic pancreatitis | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/chronic-pancreatitis/

  An MRCP involves injecting you with a substance known as a contrast agent that makes your pancreas and surrounding organs, such as the gallbladder and liver, show up very clearly on a magnetic resonance imaging (MRI) scanner. […] Sometimes, the symptoms of chronic pancreatitis can be very similar to pancreatic cancer. Therefore, if you have symptoms such as jaundice (yellowing of the skin and whites of the eyes) and weight loss, a biopsy may be recommended to rule out a diagnosis of pancreatic cancer. […] A biopsy involves taking a small sample of cells from the pancreas and sending it to a laboratory, so it can be checked under a microscope for the presence of cancerous cells.

• #82 Patient education: Chronic pancreatitis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-pancreatitis-beyond-the-basics/print

  Chronic pancreatitis can lead to a variety of complications, including the following (see „Overview of the complications of chronic pancreatitis”): […] It can be difficult to diagnose chronic pancreatitis; the signs and symptoms can be similar to those caused by other health problems, such as an ulcer, gallstones, irritable bowel syndrome, or even pancreatic cancer. […] Blood tests can detect digestive enzymes that leak out of the pancreas into the bloodstream when the pancreas is inflamed. […] Stool tests can detect abnormal levels of fat in a stool sample or low levels of the pancreatic enzyme elastase. […] Imaging tests such as x-ray, ultrasound, CT scan, or MRI provide information about the structure of the pancreas, the ducts that drain the pancreas and gallbladder, and the tissues surrounding the pancreas. […] Some of the tests for chronic pancreatitis can help to determine the likelihood of having pancreatic cancer.

• #83 Patient education: Chronic pancreatitis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-pancreatitis-beyond-the-basics/print

  Chronic pancreatitis can lead to a variety of complications, including the following (see „Overview of the complications of chronic pancreatitis”): […] It can be difficult to diagnose chronic pancreatitis; the signs and symptoms can be similar to those caused by other health problems, such as an ulcer, gallstones, irritable bowel syndrome, or even pancreatic cancer. […] Blood tests can detect digestive enzymes that leak out of the pancreas into the bloodstream when the pancreas is inflamed. […] Stool tests can detect abnormal levels of fat in a stool sample or low levels of the pancreatic enzyme elastase. […] Imaging tests such as x-ray, ultrasound, CT scan, or MRI provide information about the structure of the pancreas, the ducts that drain the pancreas and gallbladder, and the tissues surrounding the pancreas. […] Some of the tests for chronic pancreatitis can help to determine the likelihood of having pancreatic cancer.

• #84 Chronic Pancreatitis | Causes, Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/p/chronic-pancreatitis

  Chronic pancreatitis is inflammation of the pancreas that worsens over time. It causes scarring and permanent damage to the pancreas. […] Diagnosing chronic pancreatitis can be challenging. Pancreatitis is sometimes misdiagnosed as constipation, heartburn, inflammatory bowel disease or irritable bowel syndrome. […] To diagnose chronic pancreatitis, a physician will perform a thorough physical exam and ask questions about the child’s medical history. Tests may include: Blood tests to see how well the pancreas is functioning and check the pancreas enzyme levels and to check the production of insulin and if the pancreas enzymes are high. […] There is no cure for chronic pancreatitis, but treatment can ease the symptoms and improve a child’s quality of life. It is important to treat chronic pancreatitis as soon as possible because repeated inflammation can cause permanent damage.

• #85 Chronic Pancreatitis | Causes, Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/p/chronic-pancreatitis

  Chronic pancreatitis is inflammation of the pancreas that worsens over time. It causes scarring and permanent damage to the pancreas. […] Diagnosing chronic pancreatitis can be challenging. Pancreatitis is sometimes misdiagnosed as constipation, heartburn, inflammatory bowel disease or irritable bowel syndrome. […] To diagnose chronic pancreatitis, a physician will perform a thorough physical exam and ask questions about the child’s medical history. Tests may include: Blood tests to see how well the pancreas is functioning and check the pancreas enzyme levels and to check the production of insulin and if the pancreas enzymes are high. […] There is no cure for chronic pancreatitis, but treatment can ease the symptoms and improve a child’s quality of life. It is important to treat chronic pancreatitis as soon as possible because repeated inflammation can cause permanent damage.

• #86 Autoimmune pancreatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/autoimmune-pancreatitis/diagnosis-treatment/drc-20369804

  Autoimmune pancreatitis is hard to diagnose, because its symptoms are a lot like those of pancreatic cancer. However, an accurate diagnosis is extremely important. Undiagnosed cancer may result in delaying or not receiving necessary treatment. […] To pinpoint the diagnosis and determine the type of AIP, blood and imaging tests are necessary. […] No single test or characteristic feature identifies autoimmune pancreatitis. Recommended guidelines for diagnosis use a combination of imaging, blood tests and biopsy results. […] Specific tests may include: Imaging tests. Tests of your pancreas and other organs may include CT, MRI, endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). […] Blood tests. You may have a test to check for elevated levels of an immunoglobulin called IgG4. IgG4 is produced by your immune system. People with type 1 AIP often have high levels of IgG4 in their blood. People with type 2 AIP usually do not.

• #87 Chronic pancreatitis | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/chronic-pancreatitis/

  An MRCP involves injecting you with a substance known as a contrast agent that makes your pancreas and surrounding organs, such as the gallbladder and liver, show up very clearly on a magnetic resonance imaging (MRI) scanner. […] Sometimes, the symptoms of chronic pancreatitis can be very similar to pancreatic cancer. Therefore, if you have symptoms such as jaundice (yellowing of the skin and whites of the eyes) and weight loss, a biopsy may be recommended to rule out a diagnosis of pancreatic cancer. […] A biopsy involves taking a small sample of cells from the pancreas and sending it to a laboratory, so it can be checked under a microscope for the presence of cancerous cells.

• #88 Chronic Pancreatitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/371772-overview

  CT is also indicated to exclude other potential intra-abdominal pathologies that present with symptoms similar to those of chronic pancreatitis, but CT cannot exclude a diagnosis of CP and cannot exclusively diagnose early or mild CP. […] EUS can also be used to diagnose parenchymal and ductal changes mainly during the early stage of CP. […] EUS-guided fine needle biopsy can be considered as the most reliable procedure for detecting malignancy.

• #89 Comprehensive review of diagnostic modalities for early chronic pancreatitis

  https://www.wjgnet.com/1007-9327/full/v27/i27/4342.htm

  Chronic pancreatitis (CP) is a progressive condition caused by several factors and characterised by pancreatic fibrosis and dysfunction. However, CP is difficult to diagnose at an early stage. Various advanced methods including endoscopic ultrasound based elastography and confocal laser endomicroscopy have been used to diagnose early CP, although no unified diagnostic standards have been established. […] This review describes and compares the advantages and limitations of the traditional and latest diagnostic modalities and suggests guidelines for the standardisation of the methods used to diagnose early CP. […] An early diagnosis of CP is challenging due to nonspecific clinical presentation. Recurrent abdominal pain with radiation to the back is the most common symptom, with Wilcox et al reporting that constant, mild pain with intermittent episodes of severe pain is described by 45% of patients.

• #90 Comprehensive review of diagnostic modalities for early chronic pancreatitis

  https://www.wjgnet.com/1007-9327/full/v27/i27/4342.htm

  Chronic pancreatitis (CP) is a progressive condition caused by several factors and characterised by pancreatic fibrosis and dysfunction. However, CP is difficult to diagnose at an early stage. Various advanced methods including endoscopic ultrasound based elastography and confocal laser endomicroscopy have been used to diagnose early CP, although no unified diagnostic standards have been established. […] This review describes and compares the advantages and limitations of the traditional and latest diagnostic modalities and suggests guidelines for the standardisation of the methods used to diagnose early CP. […] An early diagnosis of CP is challenging due to nonspecific clinical presentation. Recurrent abdominal pain with radiation to the back is the most common symptom, with Wilcox et al reporting that constant, mild pain with intermittent episodes of severe pain is described by 45% of patients.

• #91 A Novel Diagnostic Model for Chronic Pancreatitis – Brigham On a Mission

  https://www.brighamhealthonamission.org/2018/04/10/novel-diagnostic-model-chronic-pancreatitis/

  Our risk score is also practical in guiding the evaluation of suspected CP, Lee and co-investigators wrote when their research was first published in Pancreas in March 2017. […] So many patients are mislabeled with chronic pancreatitis when they very well might have something else going on, says Dr. Lee, associate director of endoscopy at BWH. […] Mislabeling these patients brings on a whole host of problems, Dr. Lee cautions. While improved imaging studies and molecular markers from pancreatic fluids or even blood and urine eventually may offer better diagnostic tests in the future, she says, its important for now to diagnose these patients the best we can with tools currently available.

• #92

  https://link.springer.com/article/10.1007/s40265-020-01360-6

  Genetic testing offers the potential to reveal treatable pancreatitis-related disorders, and can inform decision making with regard to radical therapies for persistent or severe disease such as total pancreatectomy with islet autotransplantation (TPIAT). […] The management of patients suffering from chronic pancreatitis often requires a multi-disciplinary approach, addressing pertinent symptoms as well as the sequelae of chronic inflammation and fibrosis. […] Although heavily dependent on a wide range of analgesia, endoscopic treatment such as endoscopic retrograde cholangiopancreatography (ERCP) and surgical intervention can offer long-lasting relief of symptoms. […] The most feared complication of chronic pancreatitis—the development of pancreatic cancer—has no known prevention measure to date.

• #93 Chronic pancreatitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/67

  Chronic pancreatitis is most commonly associated with chronic alcohol ingestion (75%). […] Diagnosis is based on clinical findings and imaging. […] Key diagnostic factors include presence of risk factors, abdominal pain, steatorrhoea, and jaundice. […] 1st investigations to order include computed tomography (CT) or magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS), and secretin-enhanced magnetic resonance cholangiopancreatography (s-MRCP). […] Investigations to consider include histological examination, genetic testing, indirect pancreatic function test (faecal elastase-1), faecal fat, steatocrit, direct pancreatic function tests, IgG4 levels, and therapeutic trial of corticosteroids.

• #94 A Novel Diagnostic Model for Chronic Pancreatitis – Brigham On a Mission

  https://www.brighamhealthonamission.org/2018/04/10/novel-diagnostic-model-chronic-pancreatitis/

  To address the challenge of accurately diagnosing chronic pancreatitis (CP), researchers at Brigham and Womens Hospital (BWH) have introduced a novel prediction model that combines findings of endoscopic ultrasound (EUS) with pancreatitis-specific behavioral risk factors. […] While diagnosis of CP is relatively easy in severe cases (when CT shows calcifications throughout the pancreas, for example), it can be difficult when the disease is in early to mild forms. […] Accurately diagnosing CP is essential to avoid mislabeling people whose chronic abdominal pain has other sources and to enable appropriate care and follow-up of patients who do have CP. […] The researchers created a risk score based on four variables of which three were findings during EUS: alcohol or smoking status, the number of parenchymal abnormalities, the number of ductal abnormalities, and calcifications.

• #95 Chronic pancreatitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/chronic-pancreatitis-2?lang=us

  The exocrine function may be assessed by secretin-enhanced magnetic resonance cholangiopancreatography, SMRCP (a.k.a. MRCP-S). This relatively new technique has shown promising results and may replace endoscopic measuring techniques in the near future. […] Standardized reporting terminology has been suggested for chronic pancreatitis. The most used classification is the Cambridge classification, based on the status of the main pancreatic duct (PD) and the presence of side branches abnormalities. […] Pancreatic enzyme replacement therapy (PERT) has been recommended when there are clinical symptoms or laboratory signs of malabsorption. In those patients with refractory pain, in the presence of a dilated main pancreatic duct, endoscopic treatment should be considered, and surgery usually reserved as a second option.

• #96 Endoscopic ultrasound in the diagnosis of chronic pancreatitis

  http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015000400006

  EUS has the ability to produce high-resolution ultrasonography images of the pancreas due to the proximity of the transducer to the gland, avoiding interference by air in the intestine. EUS diagnosis of CP is based on specific criteria that have been described by the International Working Group for Minimum Standard Terminology in Gastrointestinal Endoscopy. […] The number of criteria that is needed to establish the diagnosis of CP and the relative weight of each criterion has been a matter of debate for several years. […] One of the most important weaknesses of EUS in the diagnosis of CP is concern about poor interobserver agreement. […] The use of radial or linear echoendoscopes does not have a significant impact on inter observer agreement. […] A combined use of endoscopic function test and EUS has recently been brought forward as a sensitive and accurate method for early diagnosis of CP.

• #97 A proposal for a new clinical classification of chronic pancreatitis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-9-93

  The clinical course of chronic pancreatitis is still unpredictable, which relates to the lack of the availability of a clinical classification. Therefore, patient populations cannot be compared, the course and the outcome of the disease remain undetermined in the individual patient, and treatment is not standardized. […] To establish a clinical classification for chronic pancreatitis which is user friendly, transparent, relevant, prognosis- as well as treatment-related and offers a frame for future disease evaluation. […] Diagnostic requirements will include one clinical criterion, in combination with well defined imaging or functional abnormalities. […] A classification system consisting of three stages (A, B and C) is presented, which fulfils the above-mentioned criteria. Clinical criteria are: pain, recurrent attacks of pancreatitis, complications of chronic pancreatitis (e.g. bile duct stenosis), steatorrhea, and diabetes mellitus. Imaging criteria consist of ductal or parenchymal changes observed by ultrasonography, ERCP, CT, MRI, and/or endosonography.

• #98 A proposal for a new clinical classification of chronic pancreatitis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-9-93

  A new classification of chronic pancreatitis, based on combination of clinical signs, morphology and function, is presented. It is easy to handle and an instrument to study and to compare the natural course, the prognosis and treatment of patients with chronic pancreatitis. […] For the diagnosis of chronic pancreatitis we require at least one clinical criterion such as pain, (recurrent) attacks of acute pancreatitis, steatorrhea, diabetes mellitus or well-defined complications of chronic pancreatitis. These clinical criteria must be accompanied by well-defined abnormalities in imaging findings or in a direct pancreatic function test. […] Stage A is the early stage of chronic pancreatitis where complications have not yet appeared and the clinical exocrine and endocrine function is preserved.

• #99 A proposal for a new clinical classification of chronic pancreatitis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-9-93

  Stage B is the intermediate stage where chronic pancreatitis has led to complications but clinical exocrine and endocrine function is still preserved. […] Stage C is the end stage of chronic pancreatitis, where pancreatic fibrosis has led to clinical exocrine and/or endocrine pancreatic function loss (steatorrhea and/or diabetes mellitus). […] The diagnosis of chronic pancreatitis is defined by the requested criteria. The diagnosis is supplemented by the etiology. This determination is then supplemented by the staging, potential complications and potential function loss. […] The present article proposes a new clinical classification of chronic pancreatitis, which is practically easy to use and applicable for all etiologies of chronic pancreatitis. […] Therefore, a new classification for the definition and staging of CP is urgently needed and should serve as a basis to learn about and better understand the natural course of the disease and the effects of different interventions.

• #100 Chronic Pancreatitis | Choose the Right Test

  https://arupconsult.com/content/pancreatitis-chronic

  Chronic pancreatitis includes a number of progressive inflammatory diseases, such as calcifying, chronic obstructive, and steroid-responsive or autoimmune chronic pancreatitis, which lead to pancreatic damage. […] Definitive diagnosis requires a combination of diagnostic tools, such as clinical examination, imaging, endoscopic procedures, and laboratory tests of pancreatic function. […] Diagnosis of chronic pancreatitis is difficult early in the disease course, and the laboratory tests used for chronic pancreatitis have limited sensitivity for early-stage disease. No single test can be used for diagnosis. […] Instead, a combination of clinical examination, functional testing, and imaging is typically needed to make a diagnosis. Risk factor classification systems for chronic pancreatitis, which account for laboratory and nonlaboratory factors, may help clinicians determine when to proceed with testing. The American Pancreatic Association (APA) recommends that indirect pancreatic function tests be used along with imaging to rule out cancer.

• #101 Chronic pancreatitis: A diagnostic dilemma

  https://www.wjgnet.com/1007-9327/full/v22/i7/2304.htm

  The aim of this review is to: (1) summarize the available diagnostic modalities and the most recent diagnostic guidelines; (2) review emerging and novel diagnostic techniques; and (3) challenge the status quo regarding pancreatic exocrine insufficiency, specifically the accepted concept that steatorrhea occurs only with greater than 90% destruction of the gland. […] There is no universally accepted diagnostic gold standard for chronic pancreatitis. While no one radiological, clinical or endoscopic tool can definitively diagnose this disease; there is an array of diagnostic instruments, which fall into four broad categories. […] The American pancreatic association guidelines emphasize that without sufficient evidence, patients should not be mislabeled as having chronic pancreatitis, and it is better to err on the side of not labelling the patient with chronic pancreatitis, recommending longitudinal follow-up with serial imaging and physiological testing in unequivocal cases until definitive evidence is present.

• #102 Clinical and laboratory diagnosis of chronic pancreatitis | Pancreapedia

  https://pancreapedia.org/reviews/clinical-and-laboratory-diagnosis-of-chronic-pancreatitis

  The most important issue for the clinician is to think of the pancreas as a source of these symptoms. Once this connection is made and appropriate laboratory tests and imaging are done, the diagnosis of CP can be easily established or disregarded. […] Taken together, neither a generic marker nor serum levels of pancreatic enzymes can be used to establish the diagnosis of CP. […] There are clinical symptoms indicative of chronic pancreatitis, however, none of them are specific or even pathognomonic. They should make a physician think of the pancreas as a source of the patients symptoms. Laboratory tests are also indicative at best: there is no positive test proving the diagnosis of CP. Very low (LLN) pancreatic serum enzymes can be a sign of significant pancreatic exocrine insufficiency (PEI) with chronic pancreatitis (CP) as a major etiology. The same holds true for low fecal elastase as an indicator of PEI and CP being the most frequent cause.

• #103 Chronic Pancreatitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/371772-overview

  Endoscopic retrograde cholangiopancreatography (ERCP) provides the most accurate visualization of the pancreatic ductal system and is considered the gold standard for diagnosing chronic pancreatitis. […] EUS is the most sensitive imaging technique for the diagnosis of CP, mainly during the early stages of the disease, and its specificity increases with increasing diagnostic criteria. […] EUS, ERCP, MRI and CT all have comparable high diagnostic accuracy in the initial diagnosis of chronic pancreatitis. […] The clinical practice guidelines for the diagnostic cross-sectional imaging and severity scoring of chronic pancreatitis were released in October 2018 by the Working Group for the International Consensus Guidelines for Chronic Pancreatitis and include the following: Computed tomography (CT) is often the most appropriate initial imaging modality to evaluate suspected chronic pancreatitis (CP); it depicts most of the changes in pancreatic morphology.

• #104 Chronic Pancreatitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/pancreatitis/chronic-pancreatitis

  MRI coupled with magnetic resonance cholangiopancreatography (MRCP) is now frequently used for diagnosis and can show masses in the pancreas as well as provide more optimal visualization of ductal changes consistent with chronic pancreatitis. […] Endoscopic retrograde cholangiopancreatography (ERCP) is invasive and rarely used for the diagnosis of chronic pancreatitis. […] The most common pancreatic function tests do not detect mild to moderate exocrine pancreatic insufficiency with adequate accuracy. […] Direct pancreatic function tests are most useful in patients who have an earlier stage of chronic pancreatitis in whom imaging studies are not diagnostic. […] Indirect pancreatic function tests are less accurate in diagnosing earlier stages of chronic pancreatitis.

• #105 Comprehensive review of diagnostic modalities for early chronic pancreatitis

  https://www.wjgnet.com/1007-9327/full/v27/i27/4342.htm

  However, early CP cannot be diagnosed using clinical manifestations alone. […] It is currently accepted that an early or suggestive CP diagnosis can be made when three or more of the following clinical features are present: Abnormal serum or urine pancreatic enzyme concentrations; recurring upper abdominal pain; continuous heavy alcohol consumption ( 80 g alcohol/d); family history of hereditary CP or known sporadic high-risk mutations; and abnormal exocrine function. […] EUS has been reported to be the most sensitive modality for detecting fibrosis in patients with CP. […] EUS findings such as hyperechoic foci and strands, parenchymal lobularity, and a hyperechoic ductal wall are considered to be signs of pancreatic fibrosis. […] A significant advantage of EUS is its ability to image the side branches and mild contortions of the MPD in normal individuals, especially in elderly individuals.

• #106 Diagnosing Chronic Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5478450/

  Endoscopic retrograde cholangiopancreatography (ERCP) is a modality seldom used for diagnosis of CP at the present time. […] Pancreatic Function Tests (PFTs) are typically classified as indirect (noninvasive) or direct (invasive). […] Direct PFTs and EUS may have the greatest benefit in helping to diagnose early CP. […] In summary, diagnosing CP can range from routine in those with severe disease and obvious calcifications on CT imaging to elusive in those patients with early changes of CP.

• #107 Chronic Pancreatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0315/p385.html

  Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis, and scarring. […] If chronic pancreatitis is suspected, contrast-enhanced computed tomography is the best imaging modality for diagnosis. […] Although most patients present with pain, pancreatitis is painless in roughly 10% to 20% of patients. […] The diagnosis of chronic pancreatitis is made based on a patient’s history, clinical presentation, and imaging findings. […] Diagnostic tests should be chosen based on their availability after consideration of risks and benefits. […] A meta-analysis of 43 studies that included more than 3,400 patients concluded that computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography have comparably high diagnostic accuracy for chronic pancreatitis; therefore, a stepwise approach based on cost, invasiveness, and availability is recommended.

• #108 Chronic pancreatitis: A diagnostic dilemma

  https://www.wjgnet.com/1007-9327/full/v22/i7/2304.htm

  The aim of this review is to: (1) summarize the available diagnostic modalities and the most recent diagnostic guidelines; (2) review emerging and novel diagnostic techniques; and (3) challenge the status quo regarding pancreatic exocrine insufficiency, specifically the accepted concept that steatorrhea occurs only with greater than 90% destruction of the gland. […] There is no universally accepted diagnostic gold standard for chronic pancreatitis. While no one radiological, clinical or endoscopic tool can definitively diagnose this disease; there is an array of diagnostic instruments, which fall into four broad categories. […] The American pancreatic association guidelines emphasize that without sufficient evidence, patients should not be mislabeled as having chronic pancreatitis, and it is better to err on the side of not labelling the patient with chronic pancreatitis, recommending longitudinal follow-up with serial imaging and physiological testing in unequivocal cases until definitive evidence is present.

• #109 Evaluation and Diagnosis of Chronic Pancreatitis

  https://www.medscape.org/viewarticle/709095

  This activity was developed for clinicians with an interest in chronic pancreatitis. […] The difficulty of diagnosing patients with mild or early chronic pancreatitis contributes to an underdiagnosis of this condition, which is highlighted by the fact that the delay between onset of symptoms and diagnosis is often yearsmost particularly in patients without a history of alcoholism. However, the serious nature of the disease, the high risk of complications, and the severe impact of pancreatitis-associated pain on quality of life argue for a more concerted effort to diagnose those with the disease. […] Discuss the symptoms and diagnosis of chronic pancreatitis. […] The clinician’s index of suspicion determines the aggressiveness with which the diagnosis is pursued. From onset of symptoms to diagnosis, the average time lag is 62 months, but for patients without a history of alcoholism, the delay from onset of symptoms to diagnosis averages 81 months. Early diagnosis with intervention, including alcohol cessation when applicable, often slows progression or reduces complications.

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