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Chronic alcohol related pancreatitis

Authoring team

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:


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