title: Chronic pancreatitis.
abstract: OBJECTIVE
  We review selected important clinical observations reported in 2012.
  
  
  RESULTS
  Celiac disease is a risk factor for pancreatitis. Patients with recurrent acute pancreatitis likely have chronic pancreatitis, do not benefit from pancreatic sphincterotomy, and may not benefit from biliary sphincterotomy. Analysis of endoscopic ultrasonography (EUS) images with an artificial neural network (ANN) program may improve chronic pancreatitis diagnosis compared with clinical interpretation of images. In a multicenter, randomized controlled trial of chronic pancreatitis patients, 90 000 USP U of pancreatin with meals decreased fat malabsorption compared with placebo. Detection of visceral pain in chronic pancreatitis predicts pain relief from various treatments, but nonvisceral pain due to altered central pain processing may respond to agents such as pregabalin. Predictors of surgical pain relief include onset of symptoms less than 3 years and preoperatively no opioid use and less than five endoscopic procedures. Total pancreatectomy for presumed painful chronic pancreatitis remains controversial.
  
  
  CONCLUSIONS
  Celiacs are at risk for pancreatitis. The diagnosis of chronic pancreatitis may be enhanced by ANN analysis of EUS imaging. Treatment of fat malabsorption requires 90,000 USP U of lipase with meals. Relief of pain from organ directed treatment of chronic pancreatitis may depend upon timing of interventions and whether pain is visceral or nonvisceral.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, 1150 W Medical Center Drive, Ann Arbor, MI 48109-0682, USA. mdimagno@umich.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: DiMagno
authors.forename: Eugene P
authors.initials: EP
authors.lastname: DiMagno
mesh_terms: D000975:Antioxidants / Q000627:therapeutic use; D002446:Celiac Disease / Q000150:complications; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D059408:Pain Management / Q000379:methods; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D010194:Pancreatin / Q000008:administration & dosage; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D046628:Sphincter of Oddi Dysfunction / Q000150:complications
chemical_list: D000975:Antioxidants; D010194:Pancreatin