Materiały źródłowe

• #1 Treatment options in painful chronic pancreatitis: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4048072/

  Longlasting and unbearable pain is the most common and striking symptom of chronic pancreatitis. […] Pain relief and improvement in patients’ quality of life are the primary goals in the treatment of this disease. […] First-line medical options include the provision of pain medication, adjunctive agents and pancreatic enzymes, and abstinence from alcohol and tobacco. […] If medical treatment fails, endoscopic treatment offers pain relief in the majority of patients in the short term. […] However, current data suggest that surgical treatment seems to be superior to endoscopic intervention because it is significantly more effective and, especially, lasts longer. […] Once the diagnosis of CP is confirmed, patients are advised to maintain a strict abstinence from tobacco and alcohol and require longterm analgesic medications for pain control.

• #2 Chronic Pancreatitis: Diagnosis and Treatment | AAFP

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

  Treatment of chronic pancreatitis can be medical, endoscopic, or surgical. […] The goals of all treatment modalities are improved pain, improved quality of life, and decreased morbidity and mortality from endocrine and exocrine pancreatic dysfunction. […] Eliminating alcohol and tobacco use slows disease progression and lessens complications, such as cancer. […] Dietary changes, particularly eating small, frequent, low-fat meals, can also help decrease pain and complications. […] Disabling pain is the most common symptom of chronic pancreatitis. […] Pancreatic enzyme replacement is beneficial for the treatment of steatorrhea and malabsorption. […] Endoscopy can be used to treat symptomatic strictures, stones, and pseudocysts. […] One-half of patients with chronic pancreatitis will eventually require surgery, most commonly because of intractable, disabling pain. […] The most common decompression procedure is lateral pancreaticojejunostomy. […] The Whipple procedure is the most commonly performed surgery in patients with chronic pancreatitis because of its high success rate (pain relief in 85% of patients) and low mortality (less than 3%).

• #3 Chronic pancreatitis: Management – UpToDate

  https://www.uptodate.com/contents/chronic-pancreatitis-management

  Chronic pancreatitis can produce a variety of symptoms and complications that require therapy. Abdominal pain is the most common clinical feature, the most common reason for intervention, and has the most negative impact on quality of life. […] The avoidance of environmental toxins such as tobacco and alcohol are the only measures that can prevent progression of chronic pancreatitis. All other therapies are directed at managing abdominal pain, maldigestion, pancreatogenic diabetes, or the other complications of chronic pancreatitis. […] Cessation of alcohol and smoking cessation in patients with chronic pancreatitis. Cessation of alcohol (if this is the etiology of the chronic pancreatitis) and tobacco delay progression of chronic pancreatitis, and, in the case of tobacco, reduce the likelihood of subsequent pancreatic carcinoma.

• #4 Chronic pancreatitis | NHS inform

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

  In most cases of chronic pancreatitis, theres no specific treatment to reduce the inflammation and repair the damage to the pancreas. […] Treatment mainly focuses on lifestyle changes and medication to relieve the pain. Surgery is sometimes needed to treat severe chronic pain that doesnt respond to painkillers. […] People who dont smoke cigarettes and avoid drinking alcohol tend to experience less pain and live longer than those who continue to drink and smoke after receiving a diagnosis. […] Treatment for chronic pancreatitis aims to help control the condition and reduce any symptoms. […] If youre diagnosed with chronic pancreatitis, some lifestyle changes will be recommended. […] The most important thing you can do is to stop drinking alcohol, even if it isnt the cause of your condition. This helps to prevent further damage to your pancreas and may help to reduce the pain.

• #5 Chronic pancreatitis | NHS inform

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

  If you continue to drink alcohol, its likely that youll experience debilitating pain and youll be more likely to die from a complication of chronic pancreatitis. […] If you smoke, you should stop. Smoking can speed up the progress of chronic pancreatitis, making it more likely that your pancreas will lose its function. […] As chronic pancreatitis can affect your ability to digest certain foods, you may need to change your diet. […] You may be given pancreatic enzyme supplements, which is medication containing an artificial version of the enzymes produced by your pancreas. These supplements may help to improve the effectiveness of your digestive system. […] If you have chronic pancreatitis caused by problems with your immune system, treatment is relatively straightforward. The inflammation affecting the pancreas can usually be relieved using steroid medication (corticosteroids).

• #6 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. […] Treatment goals and plans should be made in conjunction with the patient and individualized based on disease severity and a patient-specific analysis of risks and benefits. […] The major goals in the treatment of chronic pancreatitis are management of pain, associated complications, and functional (endocrine and exocrine) insufficiency in order to improve quality of life. This requires a multifaceted approach, including lifestyle modifications, pharmacologic therapy, surgical intervention, and endoscopic management. […] Lifestyle and dietary modifications are key components in the general treatment approach for chronic pancreatitis. Primary lifestyle recommendations include abstinence from alcohol use and smoking cessation.

• #7 Chronic Pancreatitis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/chronic-pancreatitis

  UCSF offers state-of-the-art care for a wide range of pancreatic disorders, including chronic pancreatitis. Treatment for chronic inflammation of the pancreas depends on the cause, severity of the patient’s pain and effectiveness of previous treatment approaches. […] We begin by managing nutrition and seeking to relieve pain. If patients don’t respond to these treatments, we may consider surgical options. Our team is highly trained in the latest minimally invasive techniques and postoperative care. […] Treatment of chronic pancreatitis depends on the cause of the disease, severity of the associated pain and effectiveness of former treatment approaches. The first step of treatment focuses on relieving pain and eating a diet that is high in carbohydrates and low in fat. It is essential to stop drinking alcohol entirely.

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

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

  Eliminating tobacco use can help with the pain and associated inflammation of chronic pancreatitis. […] The pain of chronic pancreatitis may be reduced by eating small, low-fat meals and drinking enough fluids. Fasting (not eating) for several days may alleviate the pain of chronic pancreatitis; this is usually done in the hospital so that you can be given nutrients in IV fluids. […] Early in the course of chronic pancreatitis, nonprescription pain medications usually control pain. These drugs include gabapentin and nortriptyline. […] Pancreatic enzyme supplements are often recommended to relieve pain caused by pancreatitis. These enzymes replace the enzymes normally produced by the pancreas, allowing the pancreas to „rest.” However, these enzymes do not relieve pain in all people. […] Opioid pain medicines are powerful pain-relieving drugs that require a prescription. These drugs are used during a flare if pancreatic enzymes do not relieve pain. However, a major problem with opioid medicines is that some people become addicted to them and thus crave them even when they do not have pain. Thus, most clinicians use them sparingly.

• #9 Chronic Pancreatitis – Symptoms, and Treatment – ADH – Windsor Center for Digestive Health

  https://windsordigestivehealth.com/chronic-pancreatitis-symptoms-and-treatment/

  Furthermore, drinking plenty of fluids and staying hydrated is essential, particularly in cases where diarrhea is a common symptom. Quitting smoking and avoiding alcohol is highly advised as these substances can exacerbate pancreas damage. Regular exercise is recommended not only to maintain a healthy weight but also to improve overall well-being. […] Lastly, mental health support should not be overlooked. Dealing with a chronic illness can be emotionally challenging, and counseling or joining a support group can be beneficial. These lifestyle changes, while seemingly minor, can go a long way in managing Chronic Pancreatitis and enhancing the quality of life.

• #10 Treatment options in painful chronic pancreatitis: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4048072/

  For pain medication titration, the step-up approach of the analgesic ladder described by the World Health Organization (WHO) is proposed. […] Tramadol is one of the few analgesic medications to have been prospectively evaluated in painful CP and has been shown to be equivalent to more potent narcotics, with a lower incidence of gastrointestinal side-effects and less potential for addiction. […] Pancreatic enzyme supplementation is frequently used in patients with painful CP although, despite several prospective trials and meta-analysis, evidence for pain reduction through pancreatic enzyme replacement remains inconsistent. […] If sufficient pain relief cannot be achieved by medical therapy, and if there is no sign of pancreatic or biliary duct obstruction, more invasive strategies should be considered.

• #11 Pain management in chronic pancreatitis

  https://www.wjgnet.com/2307-8960/full/v12/i12/2016.htm

  A low-fat elemental diet has been extensively studied in CP for pain control, considering that it reduces pancreatic secretion and reduces pain by decreasing ductal pressure. […] The World Health Organization (WHO) analgesic ladder has been an enduring guide for the management of cancer pain for more than two decades, and it is still applicable in planning treatment for pain in CP. […] Opioids are invariably added to the pain management regimen as pain severity increases in CP. Despite this, opioids are the most prescribed medications to manage pain, and their role is controversial in nonmalignant chronic pain scenarios such as those of CP-related pain. […] Considering that the neural mechanism of pain in CP is now well established, the drugs interfering with neural transmission are expected to be efficacious.

• #12 Chronic Pancreatitis Medication: Analgesics, Other, Opioid Analgesics, Nonsteroidal Anti-Inflammatory Drugs, Hormones, Antidepressants, TCAs, Pancreatic Enzyme Supplements

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

  No curative treatment for chronic pancreatitis exists. Medical therapy is determined primarily by symptoms. If no anatomic explanation for abdominal pain can be found, medical therapy can be attempted. This therapy includes pain control with analgesic agents and a trial of noncoated pancreatic enzymes. […] The use of exogenous pancreatic enzymes to reduce pain is linked to the hypothesis that pancreatic stimulation by food causes pain. […] Initial therapy consists of acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). For severe, refractory pain, narcotic analgesics often are required, starting with the least potent agents and progressing to more potent formulations as necessary. […] Hormones can be used for the reduction of pancreatic exocrine secretion. […] These are used as dietary supplementation to aid digestion in patients with pancreatic enzyme deficiency. Several preparations are available. The aim is to provide at least 30,000 units of lipase. […] Uncoated pancrelipase is used to treat painful chronic pancreatitis based on the following rationale.

• #13 Chronic Pancreatitis Treatment Specialists – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/gastroenterology/pancreatitis/chronic-pancreatitis

  Painful chronic pancreatitis or multiple recurrent episodes of pancreatitis that are not controlled with standard medical and surgical treatments may require the removal of the whole pancreas (total pancreatectomy) to relieve severe symptoms. […] Our pancreatic care team provides long-term outpatient follow-up care to ensure patients are comfortable and that optimal therapy is provided. […] Treatments for chronic pancreatitis include the following: Alcohol avoidance: Avoiding alcohol will help reduce pain and significantly decrease progression of the disease. Modified diet: Many patients with chronic pancreatitis feel better if they switch to a diet low in fat and eat smaller, more frequent meals. Pancreatic enzyme supplements: If the pancreas is not working properly, physicians prescribe pancreatic enzyme supplements to aid in digestion and to assure absorption of food. These pancreatic enzyme supplements help the digestion of food and improve symptoms of fatty diarrhea (steatorrhea), bloating, and abdominal distention and frequently help lessen abdominal pain. Pain-relieving medicines: Non-narcotic pain-relieving drugs can help relieve pain. When these medicines are not enough, narcotic analgesics are used. These drugs are highly effective at relieving pain, but they also pose risks for drug dependency, so physicians prescribe them cautiously. Our team works closely with UChicago Medicine’s pain management specialists to optimize care and assure pain control.

• #14 Conservative Therapy of Chronic Pancreatitis | Pancreapedia

  https://pancreapedia.org/reviews/conservative-therapy-of-chronic-pancreatitis

  Pregabalin […] Pregabalin displays effects similar to gamma aminobutyric acid (GABA). However, it does not bind to GABA receptors. Pregabalin binds to a subunit of voltage dependent calcium channels in the central nervous system (CNS). Pain processing by the CNS seems to be abnormal in patients with chronic pancreatitis. The additional role of alcohol in pain processing is only partly understood. In a randomized, double-blind, placebo-controlled trial in 64 patients with pain due to chronic pancreatitis, pregabalin as an adjuvant analgesic was superior to placebo after 3 weeks of treatment (52). The same group finds that these inhibitory effects on central sensitization may be due to inhibition of spreading hyperalgesia (9).

• #15 Treatment Strategies for Chronic Pancreatitis (CP)

  https://www.mdpi.com/1424-8247/18/3/311

  Numerous studies have shown significant benefits from using PERT, including improvement in body weight and BMI, reduced stool frequency, and overall improvement in quality of life. […] Pain management in CP is based on the analgesic ladder provided by the WHO, with non-opioid analgesics being the first-line treatment, while adjuvant analgesics such as pregabalin can be added to enhance pain control. […] AIP is a rare and complex disease that typically shows a remarkable response to corticosteroid therapy. However, in cases of intolerance or relapse on steroids, alternative therapies such as rituximab and other immunomodulators have been effectively utilized. […] Emerging studies on the use of biologics, including adalimumab and ustekinumab, are particularly promising for the management of refractory or relapsing cases of AIP.

• #15 Treatment Strategies for Chronic Pancreatitis (CP)

  https://www.mdpi.com/1424-8247/18/3/311

  Chronic pancreatitis (CP) and autoimmune pancreatitis (AIP) are diseases with overlapping features, both requiring complex management strategies. CP is characterized by pancreatic exocrine insufficiency (PEI) and pain, with treatment focused on symptom relief through pancreatic enzyme replacement therapy (PERT), pain control, and lifestyle and nutritional changes. However, the standard therapy does not address the underlying inflammation or fibrosis, which drives disease progression. […] The newest European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency (PEI) from 2024 recommend that pancreatic enzyme replacement therapy (PERT) is indicated for all patients with confirmed PEI. […] Pancreatic enzyme replacement therapy (PERT) is the current standard treatment of pancreatic exocrine insufficiency. PERT preparations are recommended as the first-line treatment for PEI, including pancreatin (Creon, Zenpep).

• #16 Treatment options in painful chronic pancreatitis: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4048072/

  About half of patients treated with EUS-guided coeliac block for painful CP experience a significant decrease in pain. […] A more invasive procedure that is similar to the percutaneous or endoscopic coeliac plexus block is bilateral thoracoscopic splanchnicectomy. […] Endoscopic therapy aims to relieve pain by draining the main pancreatic or biliary duct to reduce the pressure of the pancreatic parenchyma. […] Classical indications for surgery in CP are stenosis of the common bile duct or the duodenum, vascular obstruction, pseudocysts, the suspicion of neoplasm, and abdominal pain that fails to respond to conservative and endoscopic treatment options. […] The main purpose of a surgical intervention in CP is the relief of pain and the simultaneous preservation of as much of the pancreatic parenchyma as possible.

• #17 Chronic Pancreatitis: Symptoms, Causes, and Treatment

  https://patient.info/digestive-health/chronic-pancreatitis-leaflet

  If the pain is persistent you may be offered a procedure to block the nerve supply to the area. Examples of treatments which involve this approach are coeliac plexus block and spinal cord stimulation. […] If you need surgery, your surgeon will be able to discuss with you in detail the type of operation you need.

• #18 Pain Management – Mission: Cure

  https://mission-cure.org/managing-pancreatitis/pain-management/

  Current guidelines recommend clinicians approach pain management through a series of steps. These steps include: For patients determined to have pain primarily from their pancreas: Stop smoking and alcohol, optimize nutrition; Consider endoscopy if there are stones or strictures; Start treatment with acetaminophen or NSAID in selected cases; Consider non-coated enzymes or combine with antioxidants; Follow the patients! […] Pain medication can be used to treat pancreatitis pain with the guidance of a doctor. Pain medications include steroids, anti-inflammatory painkillers, mild painkillers, stronger painkillers, opioids, and nerve blockers. Typically, doctors will recommend milder painkillers before moving on to stronger painkillers and other medications to treat pancreatitis pain. […] PERT comes in two forms: uncoated and coated. Uncoated PERT may help reduce chronic pancreatitis pain in some patients. An example of uncoated PERT that has shown to be effective for pancreatitis pain includes Viokace. PERTs work to mimic the function of the pancreas by improving fat and protein absorption in exocrine pancreatic insufficiency (EPI). Please know that other PERTs, while effective for EPI, have not shown to be effective for pancreatitis pain.

• #19 Conservative Therapy of Chronic Pancreatitis | Pancreapedia

  https://pancreapedia.org/reviews/conservative-therapy-of-chronic-pancreatitis

  Antioxidants […] Increased levels of free oxygen radicals have been detected in the serum and pancreatic juice of patients with chronic pancreatitis. Thus, treatment with antioxidants could help to prevent and treat pain by reducing cellular damage from pancreatitis. One initial study involving patients with recurrent acute and chronic pancreatitis demonstrated a significant improvement in the number of acute exacerbations as well as in chronic pain. However, per protocol analysis only 20 of the initial 28 patients could be assessed (73). In another study an improvement of pain could also be demonstrated. However, the number of patients who could be analyzed was much too low to draw any conclusions (36). In a double-blind placebo-controlled study from India, 71 patients were treated with antioxidants and 56 with placebo over a period of six months. There was a reduction of the days with pain in the treatment arm (6), but these results were not confirmed in a recent controlled trial carried out in the U.K. (62). A later study, again from India, found a reduction of serum surrogate markers of fibrosis and a reduction of pain in patients treated with antioxidants (19). A combination of pregabalin (see below) and antioxidants caused an amelioration of pain recurrence in patients who were still free of narcotics and whose pancreatic duct has been cleared of stones (67). According to a recent meta-analysis the authors recommend antioxidant supplements for patients with low antioxidant levels in their blood (78). Another meta-analysis came to the conclusion that antioxidants can reduce pain slightly in patients with chronic pancreatitis. The clinical relevance of this small reduction is uncertain, and more evidence is needed (2). However, adverse events in one of six patients may prevent the use of antioxidants. Furthermore, the effects of antioxidants on other outcome measures, such as use of analgesics, exacerbation of pancreatitis and quality of life remain uncertain because reliable data are not available (2). The pathogenesis of pain in chronic pancreatitis is rather complex and often not understood in the individual patient to be treated. Pain may be due to inflammatory infiltration of sensory nerves, ductal hypertension due to ductal scars or protein precipitates, an inflammatory mass or pseudocysts with compression of adjacent organs etc. Duration of the disease, concomitant smoking, or alcohol abuse, prior therapy such as interventional endoscopy or surgery, need for narcotics as pain medication, and numerous further factors may have had an influence in the studies which tested the effect of an additional supplementation with antioxidants (25). In summary, convincing evidence that antioxidants have a role in the treatment of pain from chronic pancreatitis is still lacking. Furthermore in most of the studies mentioned, antioxidant medication contained beta-carotene; application of beta-carotene may be associated with the development of bronchial carcinoma in smokers who comprise the majority of patients with alcoholic chronic pancreatitis (1, 53).

• #20 Chronic Pancreatitis | Cedars-Sinai

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

  Day-to-day treatment includes: […] Pain medicine, pancreatic enzyme supplements with every meal, insulin if you develop diabetes, and vitamin supplements if needed. […] If you have been diagnosed with chronic pancreatitis, your healthcare provider may suggest lifestyle changes.

• #21 Treatment for Pancreatitis – NIDDK

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

  Treatment for chronic pancreatitis may help relieve pain, improve how well the pancreas works, and manage complications. […] Your doctor may prescribe or provide the following: […] Medicines and vitamins. Your doctor may give you enzyme pills to help with digestion, or vitamins A, D, E, and K if you have malabsorption. He or she may also give you vitamin B-12 shots if you need them. […] Treatment for diabetes. Chronic pancreatitis may cause diabetes. If you get diabetes, your doctor and health care team will work with you to create an eating plan and a routine of medicine, blood glucose monitoring, and regular checkups. […] Surgery. Your doctor may recommend surgery to relieve pressure or blockage in your pancreatic duct, or to remove a damaged or infected part of your pancreas. Surgery is done in a hospital, where you may have to stay a few days.

• #21 Treatment for Pancreatitis – NIDDK

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

  In patients who do not get better with other treatments, surgeons may perform surgery to remove your whole pancreas, followed by islet auto-transplantation. Islets are groups of cells in your pancreas that make hormones, including insulin. After removing your pancreas, doctors will take islets from your pancreas and transplant them into your liver. The islets will begin to make hormones and release them into your bloodstream. […] Procedures. Your doctor may suggest a nerve block, which is a shot of numbing medicine through your skin and directly into nerves that carry the pain message from your pancreas. If you have stones blocking your pancreatic duct, your doctor may use a procedure to break up and remove the stones.

• #22 Chronic pancreatitis – Guts UK

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

  Pancreatic exocrine insufficiency (PEI) is treated with pancreatic enzymes known as Pancreatic Enzyme Replacement Therapy (PERT). They contain the pancreatic enzymes to help replace the enzymes a normal pancreas would produce. These are given in tablet or powder form. They are taken spread throughout every meal. […] Many people with chronic pancreatitis develop secondary or Type 3c diabetes and are wrongly diagnosed with Type 2 diabetes. This leads to inadequate treatment. For people with Type 3c diabetes the treatment includes medications that regulate blood sugar control, but many people need to take insulin. […] Surgery is only offered in special pancreas centres after careful investigation and discussion. Operations to drain dilated ducts and remove inflamed tissue may relieve pain in some people.

• #22 Chronic pancreatitis – Guts UK

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

  Chronic pancreatitis is a complex disease that can have a huge impact on quality of life. It is vital to give up both smoking and alcohol even if they are not the primary causes of your pancreatitis. Both are known to make the disease worse. […] A multidisciplinary team (MDT) approach to care is required. This includes general practitioners (GP), pancreas specialists in the hospital, specialist nurses and dietitians. Some people need access to specialist care for treatment of complications, including diabetes, pain and psychological services. Unfortunately, there are no curative treatments for chronic pancreatitis. The aim is to prevent further damage to the pancreas to help: Slow disease progression, Control symptoms, Reduce complications, Improve quality of life. […] Pain is treated using a step-up approach with oral pain killers. The minimum effective treatment is used at any time to give pain-relief while minimising side-effects. If ‘simple’ pain-killers such as paracetamol are ineffective, stronger drugs may be needed.

• #23 Pancreatitis: Symptoms, Causes & Treatment

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

  Long-term pain management can be complex. You may need to experiment with a variety of different medications and procedures to find what works for you. Make sure to stay in touch with your healthcare provider about your pain, especially if what you’re doing isn’t working. They can refer you to a chronic pain specialist to help you manage your pain. In some cases, endoscopic procedures to remove scar tissue or pancreas stones may improve your symptoms. Injection of local anesthetic agents into the nerves of the pancreas (celiac plexus block) is another option for selected patients. […] Over time, many people with chronic pancreatitis can develop exocrine pancreatic insufficiency (EPI). These people will need to take pancreatic enzymes in supplement form. You might also need to take nutritional supplements to get enough calories and micronutrients (vitamins and minerals). Some people will develop glucose intolerance and eventually diabetes, becoming insulin-dependent.

• #24 Chronic Pancreatitis: Symptoms, Causes and Treatment | Ada

  https://ada.com/conditions/chronic-pancreatitis/

  If the pancreas is no longer producing enough digestive enzymes, pancreatic enzyme supplements can help support the digestive system. […] If a person with chronic pancreatitis has also developed diabetes, they should be referred to an endocrinologist. This type of diabetes is called pancreatogenic diabetes or type 3c diabetes mellitus. […] Surgery can be used to clear blockages in the pancreatic duct. In serious cases, the pancreas may be partially or wholly removed. […] Where a person with chronic pancreatitis experiences pain, this can be managed with painkillers. Mild to moderate pain can be managed with painkillers such as ibuprofen or paracetamol. More serious pain may require stronger painkillers. […] Episodes of acute pancreatitis will often require a stay in hospital, to be treated with fluids administered intravenously, painkillers, drugs to reduce nausea and vomiting, feeding by tube or intravenously if the person cannot eat, and antibiotics if the person has an infection in the pancreas.

• #25 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. […] Recommended lifestyle modifications include cessation of alcohol and tobacco use and eating small, frequent, low-fat meals. […] Although narcotics and antidepressants provide the most pain relief, one-half of patients eventually require surgery. […] Therapeutic endoscopy is indicated to treat symptomatic strictures, stones, and pseudocysts. […] Decompressive surgical procedures, such as lateral pancreaticojejunostomy, are indicated for large duct disease (pancreatic ductal dilation of 7 mm or more). […] Resection procedures, such as the Whipple procedure, are indicated for small duct disease or pancreatic head enlargement. […] Although it is not known if screening improves outcomes, clinicians should counsel patients on this increased risk and evaluate patients with weight loss or jaundice for neoplasm.

• #26 Chronic pancreatitis – Wikipedia

  https://en.wikipedia.org/wiki/Chronic_pancreatitis

  Endoscopic treatments, including removal of stones in the pancreatic duct, and dilation of strictures may be done. Extracorporeal shockwave lithotripsy can also be done, in which external acoustic waves are administered to break the stones. This may be combined with endoscopic retrograde cholangiopancreatography to collect larger stones. […] Behavioral treatments such as cognitive behavioral therapy including resilience training, stress management, chronic pain rehabilitation programs and addiction treatment may also be used as adjunct treatments. […] Pancreatic enzyme replacement is often effective in treating the malabsorption and steatorrhea associated with chronic pancreatitis. Treatment of CP consists of the administration of a solution of pancreatic enzymes with meals. Some patients do have pain reduction with enzyme replacement, and since they are relatively safe, giving enzyme replacement to a chronic pancreatitis patient is an acceptable step in treatment for most patients. Treatment may be more likely to be successful in those without the involvement of large ducts and those with idiopathic pancreatitis.

• #27 Chronic pancreatitis – Treatment abroad

  https://www.gsdinternational.com/conditions/chronic-pancreatitis

  Pancreatic pseudocysts that are symptomatic, i.e., causing pain, compression symptoms, or have become overinfected, can be drained by echoendoscopy. […] In case of chronic symptomatic pancreatitis and/or with a tendency to develop complications, such as biliary or duodenal obstruction that cannot be definitively resolved endoscopically, or in all cases in which there is a doubt of neoplasia, surgery is the treatment of choice and can include both resective surgery (in „mass-forming” forms that infiltrate the biliary tract or duodenum) and derivative surgery (decompression of the pancreatic duct). […] Sometimes total pancreasectomy is necessary to achieve resolution of pain and complications, associated, when possible, with autologous transplantation of pancreatic insulae to reduce the risk of diabetes.

• #27 Chronic pancreatitis – Treatment abroad

  https://www.gsdinternational.com/conditions/chronic-pancreatitis

  The complexity of the clinical presentation therefore requires that treatment be carried out after multidisciplinary discussion in facilities with specific expertise of gastroenterologists/endoscopists, surgeons, radiologists, nutritionists, pain therapists, immunologists, geneticists, diabetologists, anatomopathologists.

• #28 Current Surgical Treatment Options in Chronic Pancreatitis | Pancreapedia

  https://pancreapedia.org/reviews/current-surgical-treatment-options-in-chronic-pancreatitis

  If medical therapy proves insufficient, and there is no sign of pancreatic or biliary duct obstruction, more invasive non-operative strategies like coeliac nerve block may be considered. EUS-guided techniques have in this context proven safer, more effective, and longer lasting than fluoroscopy-guided or CT-guided techniques. However, coeliac nerve block usually generates a transient effect, with only 10% of patients still experiencing pain relief after 24 weeks. Therefore, this option seems more reasonable in patients with malignant disease and a anticipated short life span. […] In patients with CP and obstruction of the pancreatic duct, endoscopic treatment for ductal decompression including papillotomy, stone removal, and/or stent implantation is another widely used treatment option. Classical indications for surgery in CP are pancreatic duct obstruction, vascular obstruction, suspicion of neoplasm, and abdominal pain with failure of conservative treatment options.

• #28 Current Surgical Treatment Options in Chronic Pancreatitis | Pancreapedia

  https://pancreapedia.org/reviews/current-surgical-treatment-options-in-chronic-pancreatitis

  Severe recurrent upper abdominal pain is the most common and prominent symptom of chronic pancreatitis patients. Therefore, pain relief and improvement in patients quality of life are the primary goals in the treatment of this disease. As a first approach, patients should be managed conservatively. If medical treatment fails, endoscopic intervention can offer pain relief in the majority of patients in the short term. However, recent data suggests that – at least in complex disease – surgical treatment is superior to endoscopic intervention since it provides superior long-term results. Several surgical drainage procedures and resection techniques have been introduced and proven to be effective. However, the duodenum preserving surgical techniques should be favored, since they are safer and even more efficient than the classical Whipples procedure. They have shown to offer adequate pain control and improvement in quality of life in most patients. At the same time they can be performed with low morbidity and mortality rates, preserving endocrine and exocrine function of the pancreas and therefore ensuring an improvement of patients quality of life.

• #29 Chronic Pancreatitis | AAFP

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

  Therapeutic indications for ERCP include treatment of symptomatic stones, strictures, and pseudocysts. […] Ductal decompression by sphincterotomy or stent placement offers pain relief in most patients. […] One half of all patients will undergo surgery during the course of their disease. […] Most patients undergo surgery when the initial medical and endoscopic treatments fail to relieve intractable abdominal pain. […] Surgery is also indicated for obstruction of surrounding structures, hemorrhage, and suspected neoplasia. […] Decompression procedures are used in patients with large duct disease. […] Lateral pancreaticojejunostomy is commonly performed and yields pain relief in 60 to 91 percent of patients; recent studies have found it to be more effective than endoscopic drainage for long-term pain relief.

• #30 Treatment options in painful chronic pancreatitis: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4048072/

  A study published by Nealon and Thompson suggested that early operative duct decompression should be performed in patients with CP because it can delay the progressive functional destruction of the pancreas. […] The first surgical attempts to relieve pancreatic pain in CP were initiated in the early 19th century and were focused on the draining of the pancreatic duct by means of pancreatostomy or pancreatic left resection. […] This drainage operation has been shown to facilitate longterm pain relief in around 60-70% of patients, although some groups have reported even higher success rates of up to 98% in selected patients. […] When it comes to the issue of which of these procedures represents the optimal choice, evidence is limited to some monocentre trials and two meta-analyses. […] Although 24 months may not represent a sufficiently long period for the estimation of longterm results, it is hoped that the trial will provide a better idea of the short-term outcomes and morbidity rates associated with these procedures.

• #31 Chronic Pancreatitis – Pancreas Disease | UCLA Health

  https://www.uclahealth.org/medical-services/pancreas-disease/pancreatic-conditions/chronic-pancreatitis

  Chronic pancreatitis can be very painful. Our experts specialize in treating this condition and work tirelessly to help our patients find much-needed pain relief. UCLAs Agi Hirshberg Center for Pancreatic Disease is also one of only a few places nationwide where patients can receive auto-islet transplant for chronic pancreatitis. […] The first step in treating pain associated with chronic pancreatitis is to immediately stop drinking and smoking. Up to 50 percent of patients experience some pain relief when they stop drinking alcohol. […] If pain is interfering with your quality of life by causing problems like frequent hospitalization or depression, your doctor may recommend surgery. […] There are three types of surgery to relieve pain in chronic pancreatitis patients: […] Puestow procedure: This is a drainage operation for patients with an enlarged pancreatic duct. UCLAs surgical team has extensive experience with the Puestow Procedure, which isnt commonly done at many facilities.

• #31 Chronic Pancreatitis – Pancreas Disease | UCLA Health

  https://www.uclahealth.org/medical-services/pancreas-disease/pancreatic-conditions/chronic-pancreatitis

  Pancreatic resection: When the pancreatic duct is normal or narrow, or where pain comes back after a Puestow, doctors may recommend pancreatic resection. This involves surgical removal of part or all of the pancreas. In cases of total pancreas removal (pancreatectomy), patients may be eligible for auto-islet transplant to minimize lifelong insulin dependence. […] Frey procedure: Newer operations like the Frey Procedure combine drainage with limited resection and may have fewer side effects. Our expert surgeons have experience in this procedure, which is not commonly performed at other hospitals. […] While other surgeries for chronic pancreatitis vary in their ability to provide successful pain relief, total pancreatectomy can completely resolve pain associated with the condition. However, this leaves patients without the ability to produce insulin and is typically only used when other treatments have failed. UCLA is one of just a few hospitals nationwide offering auto-islet transplant for patients who undergo pancreatectomy for chronic pancreatitis. After removing the pancreas, specialists transplant insulin-producing cells from the pancreas to the liver. This procedure often eliminates or reduces the need for insulin injections.

• #32

  https://www.nhs.uk/conditions/chronic-pancreatitis/treatment/

  Treatment for chronic pancreatitis aims to help control the condition and reduce any symptoms. […] You may be given pancreatic enzyme supplements to help your digestive system work more effectively. […] Steroid medicine is recommended for people with chronic pancreatitis caused by problems with the immune system because it helps to relieve the inflammation of the pancreas. […] Pain relief is an important part of the treatment of chronic pancreatitis. […] Surgery can be used to treat severe pain in people with chronic pancreatitis. […] In the most serious cases of chronic pancreatitis, where the pancreas has been extensively damaged, it may be necessary to remove the entire pancreas (total pancreatectomy).

• #33 Chronic Pancreatitis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/chronic-pancreatitis

  UCSF’s Islet and Cellular Transplantation Center is one the few medical centers in the country to offer a total pancreatectomy performed with an islet autotransplant. This innovative dual procedure helps alleviate pain caused by pancreatitis, while preserving the ability to secrete insulin and reducing the risk of developing surgically induced diabetes. […] Patients with chronic pancreatitis have the option of having an islet auto (meaning „self”) transplant after their total pancreatectomy. During an islet autotransplant, the patient’s own islet cells are isolated from their removed pancreas and then put back into the patient, where they start producing insulin. […] While the goal is to eliminate each patient’s pain, preserve their pancreatic function and prevent diabetes, there is no guarantee that diabetes will not develop because there is no way of determining the quality of a patient’s islets before transplantation.

• #34 Chronic Pancreatitis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/chronic-pancreatitis

  Patients who have a pancreatectomy with an islet autotransplant have a 50 percent chance of becoming insulin dependent for life, while patients who have only a pancreatectomy have a 100 percent chance of becoming permanently insulin dependent. […] Typically, patients spend two to three weeks in the hospital following a pancreatectomy with an islet autotransplant. During this time, patients receive an insulin drip and learn how to manage diabetes in case they develop the condition.

• #35 Chronic Pancreatitis Treatment Specialists – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/gastroenterology/pancreatitis/chronic-pancreatitis

  If resection (removal) of the entire pancreas (total pancreatectomy) is advised, some patients may be eligible for autologous islet cell transplantation, a highly specialized procedure offered in only a few centers worldwide. Islet transplant prevents or reduces the effects of diabetes after pancreas removal. […] Total pancreatectomy with islet autotransplantation has emerged as an option for the treatment of debilitating pain in patients with chronic pancreatitis. About 70 percent of patients experience dramatic pain relief after total pancreatectomy with autologous islet cell transplantation.

• #36 About Pancreatitis – Mission: Cure

  https://mission-cure.org/chronic-pancreatitis/

  Chronic pancreatitis is a rare disease that affects about 200,000 Americans and an estimated one million people worldwide. […] Currently, there is no effective treatment for people suffering from chronic pancreatitis, but there is hope. Top pancreatic experts believe a well-funded, coordinated research and development program could lead to effective treatments. Mission: Cure is working to make that happen. […] The worlds top pancreatic experts believe a well-funded, coordinated research and development program could lead to effective treatments for chronic pancreatitis. Mission: Cure is working to make that happen. […] Since our founding in 2017, we have worked hard to advance effective treatments for pancreatitis, with the goal of developing a cure.

• #37 Developing an Effective Treatment Option for Pancreatitis, Peer Reviewed Medical Research Program, Congressionally Directed Medical Research Programs

  https://cdmrp.health.mil/prmrp/research_highlights/24Vikas_Dudeja_highlight

  Current options to manage or treat pancreatitis include pain medication, antibiotics for bacterial infection and surgery to remove gallstones that block pancreatic ducts. Currently, no drug therapies are available to treat the causes of acute or chronic pancreatitis, only pain management. […] Dr. Vikas Dudeja and his team at the University of Alabama at Birmingham hope to find a treatment option for the disease by repurposing Pirfenidone, an anti-inflammatory and anti-fibrotic drug currently approved to treat pulmonary fibrosis. […] Dudeja and his team found Pirfenidone significantly reduced the severity of chronic pancreatitis and the progression of recurrent acute pancreatitis to CP. […] The goals of this research stage are to evaluate Pirfenidone’s ability to reduce the recurrence of acute pancreatitis, improve quality of life measures, and improve patient-reported outcomes. […] If the current clinical trials for Pirfenidone as a treatment option for pancreatitis prove successful, they will be the first drug therapy treatment options for this condition.

• #38 Promise for Novel Treatment of Chronic Pancreatitis | UPMC Physician Resources

  https://www.upmcphysicianresources.com/news/041521-chronic-pancreatitis

  UPMC Childrens Division of Pediatric Endocrinology, Diabetes, and Metabolism researcher Mohamed Saleh, MD, conducted a new study investigating a novel, nonsurgical approach to treating chronic pancreatitis and its related complications. […] Dr. Saleh and colleagues’ research tested a novel ablative approach of the exocrine pancreas using an infusion of acetic acid administered through the pancreatic duct. Not only did this approach entirely ablate the exocrine pancreas, but it also left islet cells and their function intact. Additional results obtained post-infusion showed resolution of pain associated with chronic pancreatitis and markers of chronic inflammation, which is typical in cases of chronic pancreatitis. […] The treatment approach also may have the ability to prevent or reverse pancreatitis-induced diabetes; however, additional research will need to be conducted by Dr. Saleh and his colleagues to prove this point.

• #39 Stem Cell Treatment for Chronic Pancreatitis | Swiss Medica

  https://www.startstemcells.com/chronic-pancreatitis.html

  Suffering from chronic pancreatitis can have a significant burden on the life of an individual. It is a condition that is known to be irreversible, and it affects how a person’s body is able to digest food. While there are several treatment options available for patients, most only take care of symptoms and many patients do not want to consider surgical options for various reasons. […] The use of stem cell therapy for pancreatitis is one treatment that holds a lot of promise. […] However, opting for a program that uses stem cell therapy for pancreatitis can be a very promising alternative. It has the potential to improve symptoms of pancreatitis to a greater extent than traditional treatment, especially with the prospect of stem cell pancreas regeneration. […] Chronic pancreatitis is a condition that has no definitive cure. Many patients are not satisfied with using medication or the option of surgery. Stem cell therapy offers a promising opportunity for them to get better and improve their quality of life.

• #40 Caring for Patients With Chronic Pancreatitis

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

  Most patients with chronic pancreatitis will require pancreatic enzyme supplementation to achieve adequate nutritional status and to avoid complications such as steatorrhea. […] 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.

• #41 Chronic pancreatitis for the clinician. Part 2: Treatment and follow-up. Interdisciplinary position paper of the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees | Gastroenterología y Hepatología (English Edition)

  https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-english-edition–382-articulo-chronic-pancreatitis-for-clinician-part-S2444382421001590?covid=Dr56DrLjUdaMjzAgze452SzSInMN&rfr=truhgiz&y=kEzTXsahn8atJufRpNPuIGh67s1

  Chronic pancreatitis is associated with impaired quality of life, high incidence of comorbidities, serious complications and mortality. Healthcare costs are exorbitant. […] The therapeutic approach should include assessment of etiological factors, clinical manifestations and complications. The complexity of these patients advocates for detailed evaluation in multidisciplinary committees where conservative, endoscopic, interventional radiology or surgical options are weighed. Specialized multidisciplinary units of Pancreatology should be constituted. Indications for surgery are refractory pain, local complications, and suspicion of malignancy. Enzyme replacement therapy is indicated if evidence of exocrine insufficiency or after pancreatic surgery. Response should be evaluated by nutritional parameters and assessment of symptoms. A follow-up program should be planned for every patient with chronic pancreatitis.

• #42 Treating Chronic Pancreatitis – Acıbadem Healthcare Services

  https://acibademinternational.com/news/modern-solutions-in-treating-chronic-pancreatitis/

  Chronic pancreatitis is an inflammatory disease of the pancreas, affecting 50 out of 100,000 people. […] Up to now there is unfortunately no causal therapy of the disease, therefore physicians dealing with chronic pancreatitis are more dealing with the treatment of the concomitant complications as evidenced by Prof. Dr. Gralp Ceyhan, one of the top physicians at ACIBADEM clinics, internationally known for its success in the surgical approach to pancreatic diseases. […] So, the advice of top specialists, including Prof. Ceyhan, is that patients should go as soon as possible to a multidisciplinary specialized center for pancreatic disease. […] Depending on the situation, patients can be primarily treated with stents to reduce pain and jaundice. […] However, the problem does not remain only in the pancreas.

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