Chronic Pancreatitis

A 52-year-old man reports having had two to three episodes of acute pancreatitis each year for the past 6 years. During the past 6 months, debilitating, continuous upper abdominal pain has gradually developed despite escalating treatment with meloxicam, tramadol, and, recently, oxycodone. He has three to four bulky, foulsmelling stools daily; he reports no weight loss. He has a 20-year history of alcohol use and a 25 pack-year smoking history. He has left his position at a company owing to frequent absences. Computed tomography of the abdomen reveals scattered pancreatic ductal calcifications, a dilated pancreatic duct, and an atrophic pancreas.