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How can chronic pancreatitis be treated?

Wednesday, 14 May 2008
Answered by: Dr. B.S. Anand
Gastroenterologist,
Houston,
USA
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Q. I am a 38 years old male suffering from chronic pancreatitis and have been hospitalised several times due to this. My magnetic resonance cholangio-pancreatography (MRCP) findings report that my intrahepatic biliary radicles are not dilated, the right and left hepatic duct confluence is normal. The extrahepatic bile duct is prominent (7.7 mm) with smooth narrowing of distal intrapancreatic duct and no intraductal calculus has been seen. Further, there is irregular narrowing of the pancreatic duct in the neck, body & tail region and it is dilated measuring 7 mm in diameter. The pancreas in the tail region is diffusely attenuated. The side branches are dilated. As per the report, there is a small hypointense filling defect in the duct and the accessory pancreatic duct is prominent. There are no large pancreatic/ peripancreatic collections seen and my gall bladder is normal. How can chronic pancreatitis be treated?

A.  The most common cause of chronic pancreatitis is alcohol consumption. You did not mention whether you were using alcohol and whether you have stopped. I suggest the following steps. 1. Stop alcohol completely 2. Use pancreatic enzyme supplements along with a proton pump inhibitor (PPI) 3. If there is no benefit in pain, the next step is to consider endoscopic dilatation of the pancreatic stricture, if possible. 4. If pain persists despite endoscopic dilatation, resection of the pancreas should be discussed. 5. If pancreatic resection is not feasible, consider nerve block procedures.

A.  The most common cause of chronic pancreatitis is alcohol consumption. You did not mention whether you were using alcohol and whether you have stopped. I suggest the following steps. 1. Stop alcohol completely 2. Use pancreatic enzyme supplements along with a proton pump inhibitor (PPI) 3. If there is no benefit in pain, the next step is to consider endoscopic dilatation of the pancreatic stricture, if possible. 4. If pain persists despite endoscopic dilatation, resection of the pancreas should be discussed. 5. If pancreatic resection is not feasible, consider nerve block procedures.

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