Die chronische Pankreatitis

Chronic pancreatitis is an inflammatory, fibrosing disease with progressive loss of exocrine and endocrine function. The course is also characterized by alterations in the ductal system, in the form of calcifications and stenoses, as well as by the appearance of pseudocysts and pancreatic duct stones. Exocrine and endocrine insufficiency, together with a complex pain syndrome, lead to massive restrictions in the quality of life. Exacerbations of pain are mostly caused by acute episodes of inflammation, obstruction of the pancreatic duct (and/or bile duct) and local complications, such as pseudocysts. The goal is an early diagnosis and reduction of risk factors (alcohol and nicotine) in order to halt progress of the disease. Furthermore, adequate pain therapy (WHO pain ladder) and a substitution of the exocrine and endocrine insufficiency with optimization of nutrient supply are necessary to preserve quality of life and prevent catabolic metabolism. If there is a lack of pain control, and if complications of chronic pancreatitis are suspected, referral to a pancreatic disease centre should be made. Here, it is possible to evaluate and implement any escalation of treatment (medicinal/endoscopic/surgical) in a multidisciplinary setting.