[Guidelines for management of patients with chronic pancreatitis. Report from a consensus conference].
Chronic pancreatitis has an incidence of 3-8 new cases per 100,000 inhabitants and year. Alcohol is the most common cause. It is, however, not an independent risk factor but rather a co-factor. Smoking and genetic predisposition are increasingly regarded as causative factors. The diagnosis is today based mainly on history and findings at imaging tests. Pain treatment starts with NSAID-medication with or without paracetamol. Oral pancreatic enzyme therapy for pain should be tested early in the course. Endoscopic stent insertion into the main pancreatic duct can be used in selected cases. Operation is not recommended until other less invasive methods have been tested but should ideally be performed before addiction to opiates occurs. Oral enzyme supplementation is effective in the majority of cases with malnutrition. Most patients with chronic pancreatitis and diabetes need insulin treatment. Interdisciplinary specialist treatment teams should be established and take responsibility for diagnosis, assessment and interventional procedures (e.g. endoscopy, surgery). Due to the low incidence of the disease 3-4 such teams/centres seem appropriate in our country to allow a critical patient load.
Ihse
Ingemar
I
Kirurgiska kliniken, Universitetssjukhuset, Lund. ingemar.ihse@kir.lu.se
Andersson
Roland
R
Albiin
Nils
N
Borgström
Anders
A
Danielsson
Ake
A
Hammarström
Lars Erik
LE
Kilander
Anders
A
Kristiansson
Marianne
M
Permert
Johan
J
Sternebring
Bengt
B
D000437:Alcoholism / Q000150:complications; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002908:Chronic Disease; D032921:Consensus; D016145:Endoscopy, Digestive System; D006801:Humans; D009748:Nutrition Disorders / Q000150:complications; D010146:Pain / Q000175:diagnosis / Q000601:surgery; D059408:Pain Management; D010183:Pancreatic Ducts / Q000601:surgery; D010195:Pancreatitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D015607:Stents; D013548:Sweden
D000894:Anti-Inflammatory Agents, Non-Steroidal
Riktlinjer för handläggning av patienter med kronisk pankreatit. Rapport från ett konsensusmöte.