In chronic alcoholic pancreatitis, there is chronic pancreatic inflammation and progressive fibrosis. Histologic patterns include chronic inflammatory pseudocysts. Chronic pancreatitis is a risk factor for pancreatic cancer, and may therefore behave like other chronic pancreatic diseases like diabetes, renal disease, atherosclerosis and COPD. Chronic pancreatitis has often been confused with multiple pancreatic diseases, and may be misdiagnosed.
Patients with CP may have several signs and symptoms, which may not include abdominal pain, nausea/vomiting, or jaundice. However, pancreatitis remains a leading cause of morbidity and mortality because of the poor prognosis of CP. A timely diagnosis and prompt treatment are indispensable for improving the clinical outcomes of patients with CP.
Recent findings provides a review of the management of patients with pancreatitis with a focus on the management of complications of the disease. Patients with symptomatic pancreatitis may be treated with non-specific and broad-spectrum antibiotics, steroids and the prophylactic administration of antibiotics is recommended in patients with infectious complications. Gastroenterologists should be consulted in patients presenting with abdominal pain and a positive stool examination. Inpatient physiotherapy is helpful as is management with analgesics, as analgesics may be beneficial for long term maintenance of an altered pancreas function and prevention of pancreatic fistula. Injection of a number of agents into the pancreas are used as a treatment option, with the most common being corticosteroids.
Factors causing chronic pancreatitis include increased workload and prolonged exposure to harmful vapors at work and smokeless tobacco. The number of alcoholic beverages consumed is a major risk factor, but neither age nor sex has a significant effect.
Although the overall survival of patients with CP is poor, some patients have been able to survive many years with a satisfactory quality of life.
Around 19.8 million Americans are affected with chronic pancreatitis annually, making it the ninth leading cause of disability in the US. Patients suffer at the highest costs in the United States, with average costs around $64,000 per year for management.
[There are several treatments available for the chronic phase of pancreatitis, but there are no definite guidelines (http://www.jdrf.org.uk/treatments.aspx) as to what treatment should be given in any particular patient]. Inpatient observation and analgesia are the most often used treatments in the acute phase of pancreatitis. Inpatient observation often involves lying-in-bed as opposed to a hospital bed to aid recovery from pancreatic disease and to protect the patient from worsening complications.
Recent findings demonstrate that treatment of chronic pancreatitis is worthwhile. Recent findings also suggest a role for lifestyle modification as well as pharmacotherapy. Further long-term studies are warranted to support these findings.
In our population, patients with chronic pancreatitis were exposed to a greater number of clinical trials compared with healthy control subjects. This trial selection bias might be an explanation for the observed improvements in clinical outcomes and decreased hospitalizations in clinical practice trials. Clinical trials in chronic pancreatitis can be difficult to implement due to the disease's chronicity and the long time durations required to obtain clinical outcomes, and further studies are needed to test whether trials in chronic pancreatitis are more effective in general than in randomized control trials.
Patients who have been treated with combination therapy have worse long-term outcomes than patients who will receive monotherapy. The majority of the patients can be stabilized with only one or two drugs; this observation supports a multidisciplinary approach to the management of chronic pancreatitis.
QOL improved following treatment of severe chronic pancreatitis. However, treatment did not result in substantial improvements in any of the 4 dimensions of the SF-36. Although treatment, when used, does not enhance QOL in chronic pancreatitis, treatment can provide a valuable means of coping with disease.
There are many common adverse events that can occur as a side effect during the 6 months of treatment with infliximab. These side effects are generally mild in nature with minimal treatment-associated morbidity.