Chronic alcoholic pancreatitis

NICE suggest that for diagnosis of chronic alcohol-related pancreatitis use all of the following:

• the person's symptoms
• imaging to determine pancreatic structure and
• tests of pancreatic exocrine and endocrine function
  • computed tomography is the first-line imaging modality for people with a history and symptoms suggestive of chronic alcohol-related pancreatitis

Management

• for people with steatorrhoea or poor nutritional status, offer pancreatic enzyme supplements
• if pain is the only symptom, do not give enzyme supplements.
  • for people with pain:
    • refer to a specialist centre for multidisciplinary assessment
    • offer surgery (in preference to endoscopic therapy) to people with large-duct (obstructive) chronic pancreatitis
    • offer coeliac axis block, splanchnicectomy or surgery to people with small-duct (non-obstructive) chronic pancreatitis if their pain is poorly controlled

Notes (2):

• alcohol misuse is the most common cause of chronic pancreatitis
  • evidence suggestst that a threshold of five drinks or more per day is associated with the development of chronic pancreatitis
  • note though that less than 5% of heavy drinkers develop chronic pancreatitis, suggesting that additional factors are involved in disease development

Reference:

• 1) NICE (June 2010). Alcohol use disorders.
• 2) Hines O J, Pandol S J. Management of chronic pancreatitis BMJ 2024; 384 :e070920 doi:10.1136/bmj-2023-070920