Chronic pancreatitis for the clinician. Part 2: Treatment and follow-up. Interdisciplinary Position Paper of the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees
Gastroenterol Hepatol. 2022 Apr;45(4):304-314.
doi: 10.1016/j.gastrohep.2021.05.016.
Epub 2021 Jun 23.
[Article in
English,
Spanish]
Authors
Xavier Molero
1
, Juan Ramon Ayuso
2
, Joaquim Balsells
3
, Jaume Boadas
4
, Juli Busquets
5
, Anna Casteràs
6
, Mar Concepción
7
, Míriam Cuatrecasas
8
, Gloria Fernàndez Esparrach
9
, Esther Fort
10
, Francisco Garcia Borobia
11
, Àngels Ginès
9
, Lucas Ilzarbe
12
, Carme Loras
13
, Miquel Masachs
14
, Xavier Merino
15
, Jorge J Olsina
16
, Valentí Puig-Diví
17
, Sílvia Salord
18
, Teresa Serrano
19
, Eva Cristina Vaquero
20
Affiliations
- 1 Servei d'Aparell Digestiu, Hospital Universitari Vall d'Hebron, Barcelona, España; Exocrine Pancreas Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España; Campus de la UAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España. Electronic address: xavier.molero@vhir.org.
- 2 Servei de Radiologia, Centre de Diagnòstic per la Imatge Clínic, Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
- 3 Campus de la UAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Servei de Cirurgia Hepato-Bilio-Pancreàtica, Hospital Universitari Vall d'Hebron, Barcelona, España.
- 4 Servei de Digestologia, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
- 5 Unitat de Cirurgia Hepatobiliar i Pancreàtica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
- 6 Servei d'Endocrinologia, Hospital Universitari Vall d'Hebron, Barcelona, España.
- 7 Campus de la UAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Servei de Gastroenterologia, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
- 8 CIBERehd, Instituto de Salud Carlos III, Madrid, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Servei d'Anatomia Patològica, Hospital Clínic, Barcelona, España.
- 9 CIBERehd, Instituto de Salud Carlos III, Madrid, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Unitat d'Endoscòpia, Servei de Gastroenterologia, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
- 10 Servei de Gastroenterologia, Hospital Universitari Doctor Josep Trueta, Girona, España; Universitat de Girona (UdG), Girona, España.
- 11 Unitat de Cirurgia Hepatobiliopancreàtica, Servei de Cirurgia General i de l'Aparell Digestiu, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
- 12 Servei de Digestiu, Hospital del Mar Parc Salut Mar, Barcelona, España.
- 13 CIBERehd, Instituto de Salud Carlos III, Madrid, España; Servei de Gastroenterologia, Unitat d'Endoscòpia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.
- 14 Servei d'Endoscòpia Digestiva, Hospital Universitari Vall d'Hebron, Barcelona, España.
- 15 Unitat d'Imatge Abdominal, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Barcelona, España.
- 16 Servei de Cirurgia Gerenal i Aparell Digestiu, Hospital Universitari Arnau de Vilanova, Lleida, España.
- 17 Campus de la UAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Servei de Digestiu, Corporació Sanitària Universitaria Parc Taulí, Sabadell, Barcelona, España.
- 18 Servei de Gastroenterologia, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
- 19 CIBERehd, Instituto de Salud Carlos III, Madrid, España; Servei d'Anatomia Patològica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
- 20 CIBERehd, Instituto de Salud Carlos III, Madrid, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Servei de Gastroenterologia, ICMDiM, Hospital Clínic, Barcelona, España; Gastrointestinal and Pancreatic Oncology Research Group, Hospital Clínic, Barcelona, España.
Abstract
Chronic pancreatitis is associated with impaired quality of life, high incidence of comorbidities, serious complications and mortality. Healthcare costs are exorbitant. Some medical societies have developed guidelines for treatment based on scientific evidence, but the gathered level of evidence for any individual topic is usually low and, therefore, recommendations tend to be vague or weak. In the present position papers on chronic pancreatitis from the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees we aimed at providing defined position statements for the clinician based on updated review of published literature and on multidisciplinary expert agreement. The final goal is to propose the use of common terminology and rational diagnostic/therapeutic circuits based on current knowledge. To this end 51 sections related to chronic pancreatitis were reviewed by 21 specialists from 6 different fields to generate 88 statements altogether. Statements were designed to harmonize concepts or delineate recommendations. Part 2 of these paper series discuss topics on treatment and follow-up. The therapeutic approach should include assessment of etiological factors, clinical manifestations and complications. The complexity of these patients advocates for detailed evaluation in multidisciplinary committees where conservative, endoscopic, interventional radiology or surgical options are weighed. Specialized multidisciplinary units of Pancreatology should be constituted. Indications for surgery are refractory pain, local complications, and suspicion of malignancy. Enzyme replacement therapy is indicated if evidence of exocrine insufficiency or after pancreatic surgery. Response should be evaluated by nutritional parameters and assessment of symptoms. A follow-up program should be planned for every patient with chronic pancreatitis.
Keywords:
Abdominal pain; Chronic pancreatitis; Diabetes mellitus; Dolor abdominal; Exocrine pancreatic insufficiency; Genetic mutations; Insuficiencia pancreática exocrina; Mutaciones genéticas; Pancreatitis crónica.
Copyright © 2021 Elsevier España, S.L.U. All rights reserved.
MeSH terms
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Follow-Up Studies
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Humans
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Pancreatitis, Chronic* / complications
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Pancreatitis, Chronic* / diagnosis
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Pancreatitis, Chronic* / therapy
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Quality of Life*
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Societies, Medical