Clinical Review: Pancreatic And Biliary DiseasesChronic Pancreatitis: Complications and ManagementApte, Minoti V. M.B.B.S., M.Med.Sci., Ph.D.; Keogh, Gregory W. M.B.B.S., F.R.A.C.S.; Wilson, Jeremy S. M.D., F.R.A.C.P.Author Information From the Pancreatic Research Group, Departments of Gastroenterology (M.V.A., J.S.W.) and Surgery (G.W.K.), Prince of Wales Hospital and University of New South Wales, Sydney, Australia. Supported by grants from the National Health and Medical Research Council of Australia and the Australian Brewers' Association. Address correspondence and reprint requests to Dr. J.S. Wilson, Department of Gastroenterology, Edmund Blacket Building, Prince of Wales Hospital, Randwick NSW 2031, Australia; e-mail [email protected] Journal of Clinical Gastroenterology: October 1999 - Volume 29 - Issue 3 - p 225-240 Buy Abstract Chronic pancreatitis is characterized by progressive and irreversible loss of pancreatic exocrine and endocrine function. In the majority of cases, particularly in Western populations, the disease is associated with alcohol abuse. The major complications of chronic pancreatitis include abdominal pain, malabsorption, and diabetes. Of these, pain is the most difficult to treat and is therefore the most frustrating symptom for both the patient and the physician. While analgesics form the cornerstone of pain therapy, a number of other treatment modalities (inhibition of pancreatic secretion, antioxidants, and surgery) have also been described. Unfortunately, the efficacy of these modalities is difficult to assess, principally because of the lack of properly controlled clinical trials. Replacement of pancreatic enzymes (particularly lipase) in the gut is the mainstay of treatment for malabsorption; the recent discovery of a bacterial lipase (with high lipolytic activity and resistance to degradation in gastric and duodenal juice) represents an important advance that may significantly increase the efficacy of enzyme replacement therapy by replacing the easily degradable porcine lipase found in existing enzyme preparations. Diabetes secondary to chronic pancreatitis is difficult to control and its course is often complicated by hypoglycaemic attacks. Therefore, it is essential that caution is exercised when treating this condition with insulin. This paper reviews recent research and prevailing concepts regarding the three major complications of chronic pancreatitis noted above. A comprehensive discussion of current opinion on clinical issues relating to the other known complications of chronic pancreatitis such as pseudocysts, venous thromboses, biliary and duodenal obstruction, biliary cirrhosis, and pancreatic cancer is also presented. © 1999 Lippincott Williams & Wilkins, Inc.