Treatment: Chronic Pancreatitis

Aimed at controlling pain and malabsorption. The management of pain in pts with chronic pancreatitis is problematic. Recent meta-analyses have shown no consistent benefit of enzyme therapy at reducing pain in chronic pancreatitis. A recent prospective study reported that pregabalin can improve pain in chronic pancreatitis and lower pain medication requirement. Surgery with ductal decompression may control pain if there is a large-duct disease. Subtotal pancreatectomy may also control pain but at the cost of exocrine insufficiency and diabetes. Malabsorption is managed with a low-fat diet and pancreatic enzyme replacement. Because pancreatic enzymes are inactivated by acid, agents that reduce acid production (e.g., omeprazole or sodium bicarbonate) may improve their efficacy (but should not be given with enteric-coated preparations). Insulin may be necessary to control serum glucose.