Chronic Pancreatitis is one of the most common causes of EPI in adults1

Chronic pancreatitis (CP) is a persistent inflammation of the pancreas that is characterized by2-4:

  • REPEATED ATTACKS OF ABDOMINAL PAIN OR CHRONIC ABDOMINAL PAIN
MAY RESULT IN DECREASED APPETITE AND WEIGHT LOSS
  • MORPHOLOGICAL CHANGES INCLUDING:
    • - Pancreatic fibrosis
    • - Acinar atrophy
    • - Distorted and blocked ducts
PROGRESSIVE AND IRREVERSIBLE
  • IMPAIRMENT OF BOTH EXOCRINE AND ENDOCRINE FUNCTIONS
    • - Steatorrhea and maldigestion
MAY RESULT IN EPI
AND DIABETES (type IIIC)5-10

Revisiting the
historical view of CP6-11

In the past, CP has been regarded as a fairly uniform and largely untreatable disorder that most commonly affects male patients who drink alcohol in excess. However, studies suggest that this perception is not only misguided and discriminatory, but also might not be a complete picture. Contemporary studies report that CP is not always a disease of alcoholics; smoking is a major, dose-dependent risk factor and diverse etiological factors include genetics, autoimmune disease, and after an episode of severe acute pancreatitis. A contemporary study has shown that approximately half of CP patients are women.

In the past, CP has been regarded as a fairly uniform and largely untreatable disorder that most commonly affects male patients who drink alcohol in excess
HISTORICAL PERCEPTION6,7
  • UNIFORM DISORDER
  • UNTREATABLE
  • MALE
  • ALCOHOLICS
    (for 6-12 y)
Contemporary studies have shown that approximately half of CP patients are women Smoking is a major, dose-dependent risk factor Diverse etiological factors include genetics, autoimmune disease, and after an episode of severe acute pancreatitis
CONTEMPORARY
STUDIES PROVIDE NEW
PERSPECTIVE8-11
  • NOT ALWAYS ASSOCIATED
    WITH ALCOHOL INTAKE
  • SMOKING CAN
    BE A MAJOR
    DOSE-DEPENDENT
    RISK FACTOR
  • DIVERSE ETIOLOGIES
    INCLUDE:
    • - Genetics
    • - Autoimmune disease
  • APPROXIMATELY 50% ARE WOMEN

Over the course of years, CP can lead to irreversible pancreatic damage12,13

CP results in progressive, irreversible destruction of the pancreas, and is usually associated with permanent loss of exocrine as well as endocrine function. The exocrine pancreas retains a large reserve capacity for enzyme secretion. Symptoms of EPI may not occur until more than 90% of pancreatic enzyme output is diminished.

Calcification of the pancreas

Abdominal CT scan reveals innumerable stones in the entire pancreas

Abdominal CT Scan reveals innumerable stones in the entire pancreas

Courtesy: Andres Gelrud, MD

Endoscopic Retrograde Cholangiopancreatography (ERCP) in a patient with chronic calcific pancreatitis

ERCP showing a severely dilated main pancreatic duct with filling defectsWhite stones extracted into the duodenum

(a) ERCP showing a severely dilated main pancreatic duct with filling defects (arrows)
(b) White stones extracted into the duodenum

Courtesy: Andres Gelrud, MD

The exact etiology of CP in many cases is only partially known2

Studies have shown a correlation with CP and the following2:

  • GENETIC PREDISPOSITION
  • AUTOIMMUNE TRIGGERS
  • DISEASE-RELATED
    (Crohn’s disease, celiac disease)
  • SMOKING
  • EXCESSIVE ALCOHOL USE
  • OBSTRUCTION OF THE PANCREAS
    (trauma, stones, tumors)
  • RECURRENT ACUTE PANCREATITIS
  • IDIOPATHIC

Learn about EPI
with cystic fibrosis Click to learn about EPI with cystic fibrosis

Learn about EPI
and other conditions Learn about EPI and other conditions

References: 1. Fieker AP, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73. 2. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001;120(3):682-707. 3. Witt H, Apte MV, Keim V, Wilson JS. Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology. 2007;132(4):1557-1573. 4. DiMagno MJ, DiMagno EP. Chronic pancreatitis. Curr Opin Gastroenterol. 2006;22(5):487-497. 5. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26 Suppl 1:S5-S20. 6. Lerch MM, Mayerle J, Aghdassi AA, et al. Advances in the etiology of chronic pancreatitis. Dig Dis. 2010;28(2):324-329. 7. Steer ML, Waxman I, Freedman S. Chronic pancreatitis. N Engl J Med. 1995;332(22):1482-1490. 8. Yadav D, Hawes RH, Brand RE, et al. Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis. Arch Intern Med. 2009;169(11):1035-1045. 9. Coté GA, Yadav D, Slivka A, et al. Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis. Clin Gastroenterol Hepatol. 2011;9(3):266-273. 10. Yadav D, Slivka A, Sherman S, et al. Smoking is underrecognized as a risk factor for chronic pancreatitis. Pancreatology. 2011;10(6):713-719. 11. Frulloni L, Gabbrielli A, Pezzilli R, et al. Chronic pancreatitis: Report from a multicenter Italian survey (PanCroInfAISP) on 893 patients. Dig Liver Dis. 2009;41(4):311-317. 12. Abdel Aziz AM, Lehman GA. Current treatment options for chronic pancreatitis. Curr Treat Options Gastroenterol. 2007;10(5):355-368. 13. DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973;288(16):813-815.