Chronic pancreatitis medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 11: Line 11:
* Management of complications<ref name="pmid18319401">{{cite journal |vauthors=Callery MP, Freedman SD |title=A 21-year-old man with chronic pancreatitis |journal=JAMA |volume=299 |issue=13 |pages=1588–94 |year=2008 |pmid=18319401 |doi=10.1001/jama.299.9.jrr80001 |url=}}</ref>
* Management of complications<ref name="pmid18319401">{{cite journal |vauthors=Callery MP, Freedman SD |title=A 21-year-old man with chronic pancreatitis |journal=JAMA |volume=299 |issue=13 |pages=1588–94 |year=2008 |pmid=18319401 |doi=10.1001/jama.299.9.jrr80001 |url=}}</ref>


=== Pain management: ===
== Pain management: ==
Pain is managed in a stepwise approach of
Pain is managed in a stepwise approach of
* General recommendations
* General recommendations
Line 33: Line 33:
=== Antioxidants: ===
=== Antioxidants: ===


=== Management of complications: ===
=== Specialized approaches: ===
Replacement [[Digestive enzyme#Pancreatic enzymes|pancreatic enzymes]] are often  effective in treating the malabsorption and [[steatorrhea]]. However, the outcome from 6 randomized trials has been inconclusive regarding pain reduction.<ref name="pmid9721175">{{cite journal |author=Warshaw AL, Banks PA, Fernández-Del Castillo C |title=AGA technical review: treatment of pain in chronic pancreatitis |journal=Gastroenterology |volume=115 |issue=3 |pages=765–76 |year=1998 |pmid=9721175 |doi=10.1016/S0016-5085(98)70157-X}}</ref>


While the outcome of trials regarding pain reduction with pancreatic enzyme replacement is inconclusive, 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 involvement of large ducts and those with idiopathic pancreatitis. Patients with alcoholic pancreatitis may be less likely to respond.
====== (a) Celiac nerve block ======
 
====== (b) Endoscopic therapy ======
 
====== (c) Extracorporeal shock wave lithotripsy ======
 
====== (d) Radiation ======
 
== Management of Steatorrhea: ==
 
====== (a) Dietary modification ======
 
====== (b) Lipase supplementation ======
 
====== (c) Vitamin supplementation ======
 
====== (d) Medium chain triglycerides ======
 
== Management of glucose intolerance: ==
 
== Management of other pancreatic complications: ==


==References==
==References==

Revision as of 17:25, 7 November 2017

Chronic pancreatitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chronic pancreatitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Abdominal X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

American Pancreatic Association Practice Guidelines

APA Clinical Practice Guidelines for Chronic pancreatiits

Chronic pancreatitis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Chronic pancreatitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chronic pancreatitis medical therapy

CDC on Chronic pancreatitis medical therapy

Chronic pancreatitis medical therapy in the news

Blogs on Chronic pancreatitis medical therapy

Directions to Hospitals Treating Chronic pancreatitis

Risk calculators and risk factors for Chronic pancreatitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Medical Therapy

The goals of management are:

  • Pain control
  • Management of pancreatic insufficiency by pancreatic enzyme replacement
  • Management of complications[1]

Pain management:

Pain is managed in a stepwise approach of

  • General recommendations
  • Pancreatic enzyme replacement
  • Analgesics
  • Other invasive procedures

General recommendations:

Most of the patients usually improve following the general recommendations with only a few requiring analgesics.

(a) Smoking cessation:
(b) Cessation of alcohol intake:
(c) Small meals and hydration

Pancreatic Enzyme Supplementation:

Analgesics:

Antioxidants:

Specialized approaches:

(a) Celiac nerve block
(b) Endoscopic therapy
(c) Extracorporeal shock wave lithotripsy 
(d) Radiation

Management of Steatorrhea:

(a) Dietary modification
(b) Lipase supplementation
(c) Vitamin supplementation 
(d) Medium chain triglycerides

Management of glucose intolerance:

Management of other pancreatic complications:

References

  1. Callery MP, Freedman SD (2008). "A 21-year-old man with chronic pancreatitis". JAMA. 299 (13): 1588–94. doi:10.1001/jama.299.9.jrr80001. PMID 18319401.


Template:WikiDoc Sources