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Gastroenterology250 papers

Chronic pancreatitis

Last edited: 4/17/2026

Overview

Chronic pancreatitis (CP) is an irreversible inflammatory condition of the pancreas leading to progressive parenchymal and ductal damage, often resulting in pain, exocrine insufficiency, and diabetes 1723.

Diagnosis

  • Clinical Presentation: Persistent abdominal pain, weight loss, steatorrhea 17.
  • Imaging: CT, MRI, endoscopic ultrasound (EUS) for parenchymal changes, ductal abnormalities, and complications 1760.
  • Functional Tests: Fecal elastase-1 for exocrine function, glucose tolerance tests for diabetes 623.
  • Grading: Cambridge classification for mild CP, using secretin-enhanced MRI/MRCP 4445.
  • Management

  • Pain Management:
  • - First-line: Pregabalin, gabapentin 44. - Adjunctive: Celiac plexus block, endoscopic ultrasound-guided interventions 556.
  • Exocrine Insufficiency: Pancreatic enzyme replacement therapy (PERT) 623.
  • Nutritional Support: Vitamin D supplementation, fat-soluble vitamin monitoring 6848.
  • Antioxidants: Antioxidants like vitamin C and E may be considered 43.
  • Special Populations

  • Pediatrics: Total pancreatectomy with islet autotransplantation for severe pain 172021.
  • Elderly: Tailored pain management, careful monitoring of comorbidities 77.
  • Comorbidities: Consider impact on drug absorption and nutritional status 41.
  • Key Recommendations

  • Regular Monitoring of Exocrine Function and Nutritional Status: Routine assessment of fecal elastase and fat-soluble vitamin levels 68 (Evidence: Strong).
  • Use of Pancreatic Enzyme Replacement Therapy: For patients with documented exocrine insufficiency 6 (Evidence: Strong).
  • Endoscopic Interventions for Pain Management: Consider endoscopic ultrasound-guided celiac plexus block in refractory cases 5 (Evidence: Moderate).
  • Multidisciplinary Approach: Involvement of gastroenterology, pain management, and nutrition specialists 24 (Evidence: Moderate).
  • Avoid Unnecessary Surgical Interventions: Selective use of surgical options like the Puestow procedure for specific indications 40 (Evidence: Expert opinion).
  • References

    Showing 100 most recent of 154 indexed papers.

    1 Gupta A, Chernyak V, Chang KJ, Bhosale PR, Cash BD, Hall KR et al.. ACR Appropriateness Criteria® Chronic Pancreatitis. Journal of the American College of Radiology : JACR 2026. link 2 Dang X, Lv S, Huang M, Fu H. Extracorporeal multi-organ support: ECMO, CRRT, and hemoperfusion for acute alcohol intoxication with renal and respiratory failure. Renal failure 2025. link 3 Sheth SG, Machicado JD, Chalhoub JM, Forsmark C, Zyromski N, Thosani NC et al.. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis: summary and recommendations. Gastrointestinal endoscopy 2024. link 4 Montorsi RM, Francken MFG, Boermeester MA, Busch OR, Daams F, Hackert T et al.. Minimally invasive versus open lateral pancreaticojejunostomy in patients with painful chronic pancreatitis: systematic review. BJS open 2024. link 5 Wilcox CM, Bang JY, Buxbaum J, Gardner TB, Hawes R, Kedia P et al.. Effect of endoscopic ultrasound guided celiac plexus block on the palliation of pain in chronic pancreatitis (EPOCH Trial): study protocol for a randomized multicenter sham-controlled trial {1}. Trials 2024. link 6 Estes-Doetsch H, Roberts K, Newkirk M, Parker A. Fat-soluble vitamin deficiency and exocrine pancreatic insufficiency among adults with chronic pancreatitis: Is routine monitoring necessary for all patients?. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2024. link 7 Cohen SM, Kent TS. Etiology, Diagnosis, and Modern Management of Chronic Pancreatitis: A Systematic Review. JAMA surgery 2023. link 8 Ukegjini K, Steffen T, Tarantino I, Jonas JP, Rössler F, Petrowsky H et al.. Systematic review on groove pancreatitis: management of a rare disease. BJS open 2023. link 9 Zeng S, Ma L, Yang L, Hu X, Wang C, Guo X et al.. Role of Hemodialysis in Acute Severe Alcohol Intoxication: A Meta-Analysis. Blood purification 2023. link 10 Takaki T, Chujo D, Kurokawa T, Kawabe A, Takahashi N, Ito K et al.. Quality of life after total pancreatectomy with islet autotransplantation for chronic pancreatitis in Japan. Islets 2023. link 11 Parhiala M, Ukkonen M, Sand J, Laukkarinen J. Osteoporosis and sarcopenia are common and insufficiently diagnosed among chronic pancreatitis patients. BMC gastroenterology 2023. link 12 Sert S. Temporary prolongation of the QT interval in acute ebastine intoxication due to challenge video on TikTok in a girl. Cardiology in the young 2023. link 13 Monaghan B, Monaghan A, Mockler D, Ul Ain Q, Duggan SN, Conlon KC et al.. Physical activity for chronic pancreatitis: a systematic review. HPB : the official journal of the International Hepato Pancreato Biliary Association 2022. link 14 Berke G, Gede N, Szadai L, Ocskay K, Hegyi P, Sahin-Tóth M et al.. Bicarbonate defective CFTR variants increase risk for chronic pancreatitis: A meta-analysis. PloS one 2022. link 15 Takáts A, Berke G, Gede N, Németh BC, Witt H, Głuszek S et al.. Risk of chronic pancreatitis in carriers of loss-of-function CTRC variants: A meta-analysis. PloS one 2022. link 16 Koliakos N, Papaconstantinou D, Tzortzis AS, Renieris G, Bakopoulos A, Schizas D et al.. Endoscopic versus surgical treatment for thoracopancreatic fistulas complicating chronic pancreatitis: A systematic review. Surgery 2022. link 17 Nathan JD, Ellery K, Balakrishnan K, Bhatt H, Ganoza A, Husain SZ et al.. The Role of Surgical Management in Chronic Pancreatitis in Children: A Position Paper From the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. Journal of pediatric gastroenterology and nutrition 2022. link 18 Dhali A, Ray S, Sarkar A, Khamrui S, Das S, Mandal TS et al.. Peripancreatic arterial pseudoaneurysm in the background of chronic pancreatitis: clinical profile, management, and outcome. Updates in surgery 2022. link 19 Cruz-Monserrate Z, Gumpper K, Pita V, Hart PA, Forsmark C, Whitcomb DC et al.. Biomarkers of Chronic Pancreatitis: A systematic literature review. Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2021. link 20 Freeman AJ, Maqbool A, Bellin MD, Goldschneider KR, Grover AS, Hartzell C et al.. Medical Management of Chronic Pancreatitis in Children: A Position Paper by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. Journal of pediatric gastroenterology and nutrition 2021. link 21 McEachron KR, Downs EM, Schwarzenberg SJ, Chinnakotla S, Bellin MD. Fat-soluble Vitamin Deficiency is Common in Children With Chronic Pancreatitis Undergoing Total Pancreatectomy With Islet Autotransplantation. Journal of pediatric gastroenterology and nutrition 2021. link 22 Liu QY, Gugig R, Troendle DM, Bitton S, Patel N, Vitale DS et al.. The Roles of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography in the Evaluation and Treatment of Chronic Pancreatitis in Children: A Position Paper From the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. Journal of pediatric gastroenterology and nutrition 2020. link 23 Gardner TB, Adler DG, Forsmark CE, Sauer BG, Taylor JR, Whitcomb DC. ACG Clinical Guideline: Chronic Pancreatitis. The American journal of gastroenterology 2020. link 24 de Rijk FE, Kempeneers MA, Bruno MJ, Besselink MG, van Goor H, Boermeester MA et al.. Suboptimal care for chronic pancreatitis patients revealed by moderate to low adherence to the United European Gastroenterology evidence-based guidelines (HaPanEU): A Netherlands nationwide analysis. United European gastroenterology journal 2020. link 25 Yang HY, Wang D, Liu Y, Han C, Xin L, Li ZS et al.. Global Status in Chronic Pancreatitis Research. Pancreas 2020. link 26 Greer JB, Greer P, Sandhu BS, Alkaade S, Wilcox CM, Anderson MA et al.. Nutrition and Inflammatory Biomarkers in Chronic Pancreatitis Patients. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2019. link 27 Shnayder MM, Mohan P. Hemosuccus pancreaticus from superior mesenteric artery pseudoaneurysm within perceived pancreatic mass. Clinical journal of gastroenterology 2019. link 28 Navarro S. Chronic pancreatitis. Some important historical aspects. Gastroenterologia y hepatologia 2018. link 29 Hu N, Shen Y, Liu F, Wu J, Yuan F, Tian L et al.. Morphological and immunobiochemical analysis of the liver in L-arginine induced experimental chronic pancreatitis. Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2017. link 30 Byikova AP, Kozlova IV. MECHANISMS OF DEVELOPMENT AND CHARACTERISTICS THE PATHOLOGY OF THE GASTROINTESTINAL TRACT IN CHRONIC PANCREATITIS. Eksperimental'naia i klinicheskaia gastroenterologiia = Experimental & clinical gastroenterology 2016. link 31 Iglesias-García J. New steps of elastography for the diagnosis of chronic pancreatitis. Revista espanola de enfermedades digestivas 2016. link 32 Gallego Otaegui L, Sainz Lete A, Gutiérrez Ríos RD, Alkorta Zuloaga M, Arteaga Martín X, Jiménez Agüero R et al.. Obstructive jaundice caused by a pancreaticoduodenal pseudoaneurysm. Revista espanola de enfermedades digestivas 2016. link 33 Kuijpers M, Klinkenberg TJ, Bouma W, Beese U, DeJongste MJ, Mariani MA. Single-port videoscopic splanchnotomy for palliation of refractory chronic pancreatitis. Interactive cardiovascular and thoracic surgery 2016. link 34 Olesen SS, Graversen C, Bouwense SA, Wilder-Smith OH, van Goor H, Drewes AM. Is Timing of Medical Therapy Related to Outcome in Painful Chronic Pancreatitis?. Pancreas 2016. link 35 de Vries M, Van Rijckevorsel DC, Vissers KC, Wilder-Smith OH, Van Goor H. Single dose delta-9-tetrahydrocannabinol in chronic pancreatitis patients: analgesic efficacy, pharmacokinetics and tolerability. British journal of clinical pharmacology 2016. link 36 Juel J, Olesen SS, Olesen AE, Poulsen JL, Dahan A, Wilder-Smith O et al.. Study protocol for a randomised, double-blinded, placebo-controlled, clinical trial of S-ketamine for pain treatment in patients with chronic pancreatitis (RESET trial). BMJ open 2015. link 37 Takahashi N, Chari ST. MRI with spin labeling for diagnosis of early chronic pancreatitis. AJR. American journal of roentgenology 2014. link 38 Olesen SS, Juel J, Nielsen AK, Frøkjær JB, Wilder-Smith OH, Drewes AM. Pain severity reduces life quality in chronic pancreatitis: Implications for design of future outcome trials. Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2014. link 39 Duggan SN, Smyth ND, O'Sullivan M, Feehan S, Ridgway PF, Conlon KC. The prevalence of malnutrition and fat-soluble vitamin deficiencies in chronic pancreatitis. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2014. link 40 Adams DB. The Puestow procedure: how I do it. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2013. link 41 Olesen AE, Brokjaer A, Fisher IW, Larsen IM. Pharmacological challenges in chronic pancreatitis. World journal of gastroenterology 2013. link 42 Jain G, Kathuria S, Nigam A, Trehan VK. Transcatheter embolization of a giant pancreatic pseudoaneurysm: a tale of two bleeds and one thrombus!. Indian heart journal 2013. link 43 Trikudanathan G, Navaneethan U, Vege SS. Modern treatment of patients with chronic pancreatitis. Gastroenterology clinics of North America 2012. link 44 Dumonceau JM, Delhaye M, Tringali A, Dominguez-Munoz JE, Poley JW, Arvanitaki M et al.. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2012. link 45 Morishita H, Yamagami T, Takeuchi Y, Matsumoto T, Asai S, Masui K et al.. A new flow control technique using diluted epinephrine in the N-butyl-2-cyanoacrylate embolization of visceral artery pseudoaneurysms secondary to chronic pancreatitis. Cardiovascular and interventional radiology 2012. link 46 Jimeno-Ayllón C, Pérez-García JI, Gómez-Ruiz CJ, García-Cano-Lizcano J, Morillas-Ariño J, Martínez-Fernández R et al.. Standard criteria versus Rosemont classification for EUS-diagnosis of chronic pancreatitis. Revista espanola de enfermedades digestivas 2011. link 47 Hall MA. Chronic pancreatitis: an update for home care and hospice clinicians. Home healthcare nurse 2011. link 48 Bang UC, Matzen P, Benfield T, Beck Jensen JE. Oral cholecalciferol versus ultraviolet radiation B: effect on vitamin D metabolites in patients with chronic pancreatitis and fat malabsorption - a randomized clinical trial. Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2011. link 49 Tokuda T, Tanigawa N, Kariya S, Komemushi A, Suzuki S, Sawada S. Transcatheter embolization for visceral pseudoaneurysm with situs inversus totalis. Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy 2011. link 50 Quilliot D, Forbes A, Dubois F, Gueant JL, Ziegler O. Carotenoid deficiency in chronic pancreatitis: the effect of an increase in tomato consumption. European journal of clinical nutrition 2011. link 51 Pezzilli R. Etiology of chronic pancreatitis: has it changed in the last decade?. World journal of gastroenterology 2009. link 52 Sarles H. The most important role of the mentor is to guide the mentee in finding own solutions to problems. An interview with Prof. Henri Sarles. Interview by Martín E. Fernández-Zapico. Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2008. link 53 Jean Louis CC, Beaumont Caminos CC, Fernández Esaín BB, Gimena Ramos I. Tropical pancreatitis: an unusual case of chronic pancreatitis in juveniles. The American journal of emergency medicine 2008. link 54 Sai JK, Suyama M, Kubokawa Y, Watanabe S. Diagnosis of mild chronic pancreatitis (Cambridge classification): comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography. World journal of gastroenterology 2008. link 55 Apiratpracha W, Yoshida EM, Scudamore CH, Weiss AA, Byrne MF. Chronic pancreatitis: a sequela of acute fatty liver of pregnancy. Hepatobiliary & pancreatic diseases international : HBPD INT 2008. link 56 Baghdadi S, Abbas MH, Albouz F, Ammori BJ. Systematic review of the role of thoracoscopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis. Surgical endoscopy 2008. link 57 Udayakumar N, Jayanthi V. Chronic pancreatitis in India: the changing spectrum. Postgraduate medical journal 2007. link 58 Uygur-Bayramiçli O, Dabak R, Kiliçoglu G, Dolapçioglu C, Oztas D. Dorsal pancreatic agenesis. JOP : Journal of the pancreas 2007. link 59 Goldschneider KR, Racadio JM, Weidner NJ. Celiac plexus blockade in children using a three-dimensional fluoroscopic reconstruction technique: case reports. Regional anesthesia and pain medicine 2007. link 60 Singh SP, Meher C, Agrawal O. Biliary ascariasis associated with chronic calcific pancreatitis of the tropics. Tropical gastroenterology : official journal of the Digestive Diseases Foundation 2006. link 61 Tsao TF, Kang RJ, Tyan YS, Gueng MK, Lee T, Lee SK. Color Doppler twinkling artifact related to chronic pancreatitis with parenchymal calcification. Acta radiologica (Stockholm, Sweden : 1987) 2006. link 62 Lévy P, Barthet M, Mollard BR, Amouretti M, Marion-Audibert AM, Dyard F. Estimation of the prevalence and incidence of chronic pancreatitis and its complications. Gastroenterologie clinique et biologique 2006. link73330-9) 63 Vimalraj V, Jeswanth S, Kannan DG, Krishnan CS, Surendran R. Acute portal vein thrombosis and massive necrosis of the liver. An unusual complication after stenting for chronic pancreatitis. JOP : Journal of the pancreas 2006. link 64 Bruno MJ. Chronic pancreatitis. Gastrointestinal endoscopy clinics of North America 2005. link 65 Garcea G, Thomasset S, Berry DP, Tordoff S. Percutaneous splanchnic nerve radiofrequency ablation for chronic abdominal pain. ANZ journal of surgery 2005. link 66 François CJ, Demos TC, Iqbal N. Pancreaticothoracic fistulas: imaging findings in five patients. Abdominal imaging 2005. link 67 Pronk NB, Haanstra WP, van der Kleij FG. Haemosuccus pancreaticus, a rare cause of upper gastrointestinal bleeding. The Netherlands journal of medicine 2003. link 68 Weber SM, Rikkers LF. Splenic vein thrombosis and gastrointestinal bleeding in chronic pancreatitis. World journal of surgery 2003. link 69 Bornman PC, Marks IN, Girdwood AW, Berberat PO, Gulbinas A, Büchler MW. Pathogenesis of pain in chronic pancreatitis: ongoing enigma. World journal of surgery 2003. link 70 Remer EM, Baker ME. Imaging of chronic pancreatitis. Radiologic clinics of North America 2002. link00044-1) 71 Natarajan A, Rozario A. Roux loop obstruction following lateral pancreaticojejunostomy masquerading as recurrent pancreatitis. Tropical gastroenterology : official journal of the Digestive Diseases Foundation 2002. link 72 Kim BC, Joo KR, Lee HS, Jeong YK, Suh HS, Kim DH et al.. A case of chronic pancreatitis associated with liver infarction and acrodermatitis enteropathica. The Korean journal of internal medicine 2002. link 73 Pathak R, Cooperman AM. Surgery and pancreas divisum: a dwindling role?. The Surgical clinics of North America 2001. link70134-1) 74 Toyono M, Nakano K, Kiuchi M, Imai K, Suzuki H, Shishikura K et al.. A case of MERRF associated with chronic pancreatitis. Neuromuscular disorders : NMD 2001. link00176-0) 75 Isla AM. Chronic pancreatitis. Hospital medicine (London, England : 1998) 2000. link 76 Takanami I. Massive haemoptysis due to chronic pancreatitis: control with inferior phrenic artery embolization. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2000. link00468-1) 77 Mishal J, Sherer Y, Magen E, Lugasi G. Transient polycythemia and multi-organ failure due to acute alcohol ingestion. Annals of hematology 2000. link 78 Tsiotou AG, Sakorafas GH. Pathophysiology of pain in chronic pancreatitis: clinical implications from a surgical perspective. International surgery 2000. link 79 Knosalla C, Bauer M, Weng Yg, Weidemann H, Hetzer R. Complicated chronic pancreatitis causing mycotic aortic aneurysm: in situ replacement with a cryopreserved aortic allograft. Journal of vascular surgery 2000. link 80 Gress F, Schmitt C, Sherman S, Ikenberry S, Lehman G. A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. The American journal of gastroenterology 1999. link 81 Baykal A, Kaynaroglu V, Aran O, Onat D. A case of renal artery stenosis secondary to chronic pancreatitis. Acta chirurgica Belgica 1999. link 82 Dhadphale S, Sawant P, Rathi P, Shirhatti RG, Gupta R, Gopanpallikar A et al.. Bleeding duodenal varix in splenic vein thrombosis and chronic pancreatitis. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 1998. link 83 Noppen M, Meysman M, D'Haese J, Vincken W. Thoracoscopic splanchnicolysis for the relief of chronic pancreatitis pain: experience of a group of pneumologists. Chest 1998. link 84 Salim AS. Perspectives in pancreatic pain. HPB surgery : a world journal of hepatic, pancreatic and biliary surgery 1997. link 85 Gambiez LP, Ernst OJ, Merlier OA, Porte HL, Chambon JP, Quandalle PA. Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis. Archives of surgery (Chicago, Ill. : 1960) 1997. link 86 Dhar P, Tomey S, Jain P, Azfar M, Sachdev A, Chaudhary A. Internal pancreatic fistulae with serous effusions in chronic pancreatitis. The Australian and New Zealand journal of surgery 1996. link 87 Sidhu S, Tandon RK. Chronic pancreatitis: diagnosis and treatment. 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    Original source

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