Chronic Pancreatitis

Chronic pancreatitis refers to progressive chronic inflammation and fibrosis along with impaired exocrine and endocrine pancreatic function, eventually leading to endocrine and exocrine failure. In the USA, pancreatitis is not an uncommon diagnosis in an ambulatory care setting in subjects over 65 years of age. 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., ampullary malignancy or pancreatic cancer). Most older adults with idiopathic chronic pancreatitis do not have pain and instead present with exocrine and endocrine insufficiency. No single test is adequately sensitive for the diagnosis of chronic pancreatitis. The diagnosis is based on clinical presentation with stool testing and radiologic imaging. Exocrine function testing and endoscopic evaluation for diagnosis are typically used when the imaging is inconclusive. Therapy targets the prevention of ongoing damage to the pancreas, alleviation of symptoms, and treating complications. Exclusion of malignancy, pancreatic enzyme replacement, and treatment of diabetes along with the 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 complications.