Chronic pancreatitis

Chronic pancreatitis refers to chronic inflammation and fibrosis of the pancreas resulting in impaired exocrine and endocrine pancreatic function. In 2004, pancreatitis was a common diagnosis in ambulatory care of the over 65 year age group in the United States, when “all-listed diagnoses” were considered. While alcohol is the most common cause of chronic pancreatitis in the general population, most cases of chronic pancreatitis in the older adult are idiopathic. Other causes in the geriatric population include those related to obstruction (e.g., pancreatic cancer) and pancreatic duct stones. Most elderly with idiopathic chronic pancreatitis do not have pain and instead present with exocrine and endocrine insufficiency. No single test is adequately sensitive in the diagnosis of chronic pancreatitis. The diagnosis is based on clinical presentation with stool testing and radiologic imaging. Functional testing and endoscopic evaluation are typically used when the imaging is inconclusive. Therapy targets prevention of ongoing damage to the pancreas, alleviation of symptoms, and treating complications. Exclusion of malignancy, pancreatic enzyme replacement along with cessation of tobacco and alcohol use are mainstays of therapy. Surgical and endoscopic interventions are reserved for those who do not respond to conservative therapy and for complicati.