Chronic pancreatitis.
OBJECTIVE
We review important new clinical observations in chronic pancreatitis reported in 2011.


RESULTS
Smoking increases the risk of nongallstone acute pancreatitis and the progression of acute pancreatitis to chronic pancreatitis. Binge drinking during Oktoberfest did not associate with increased hospital admissions for acute pancreatitis. The unfolded protein response is an adaptive mechanism to maintain pancreatic health in response to noxious stimuli such as alcohol. Onset of diabetes mellitus in chronic pancreatitis is likely due to progressive disease rather than individual variables. Insufficient pancreatic enzyme dosing is common for treatment of pancreatic steatorrhea; 90 000 United States Pharmacopeia units of lipase should be given with meals. Surgical drainage provides sustained, superior pain relief compared with endoscopic treatment in patients advanced chronic pancreatitis with a dilated main duct ± pancreatic stones. The central acting gabapentoid pregabalin affords a modest 12% pain reduction in patients with chronic pancreatitis but approximately 30% of patients have significant side effects.


CONCLUSIONS
Patients with nongallstone-related acute pancreatitis or chronic pancreatitis of any cause should cease smoking. Results of this year's investigations further elucidated the pancreatic pathobiology due to alcohol, onset of diabetes mellitus in chronic pancreatitis, and the mechanisms and treatment of neuropathic pain in chronic pancreatitis.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109-0682, USA. mdimagno@umich.edu
Matthew J
MJ
DiMagno
Eugene P
EP
DiMagno
D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D063425:Binge Drinking / Q000150:complications; D003920:Diabetes Mellitus / Q000209:etiology; D004322:Drainage; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy; D006801:Humans; D059408:Pain Management; D010195:Pancreatitis / Q000209:etiology / Q000235:genetics; D050500:Pancreatitis, Chronic / Q000150:complications / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D012907:Smoking / Q000009:adverse effects*; D056811:Unfolded Protein Response