[Chronic pancreatitis: diagnostic and therapeutic management]. / Pancréatite chronique: prise en charge diagnostique et thérapeutique.

ABSTRACT

NATURAL HISTORY Alcoholism is a common cause of chronic calcifying pancreatitis. Abdominal pain, weight loss and acute complications are the early manifestations. Besides chronic pain, about 80% of the patients develop acute pancreatitis, pseudocysts, compression of the main bile duct, serous effusion or digestive bleeding during the first five years of the disease course. Painful episodes are more frequent after 5 to 10 years, with a risk of jaundice and persistent pseudocyst formation. CHRONIC COURSE Beyond 10 years, calcified stones and fibrosis progressively replace the pancreas parenchyma. Painful events become more parse and after 15 years, diabetes and exocrine insufficiency predominate. TREATMENT Abstention from alcoholic beverages, analgesics administration and balanced diet are essential therapeutic elements. Insulin is required for the diabetes and pancreas extracts in gastroprotected microcapsules are needed to compensate for the chronic exocrine insufficiency. This medical treatment may be able to control pain but interventional radiology (pseudocyst drainage, antalgesic infiltration of the celiac plexus), interventional endoscopy (pseudocyst drainage, biliary stent, pancreatic endoprosthesis), or surgery (deviation of the bile ducts, wirsungojejunal derivation, exceptionally resection) may also be required.