Managing complications of chronic pancreatitis: a guide for the gastroenterologist

ABSTRACT

Introduction

Chronic pancreatitis is a heterogeneous and complex syndrome that, in most cases, causes pain as a cardinal symptom and affects both the morphology and function of the pancreas, leading to several serious complications.

Areas covered

The present review, based on a non-systematic PubMed search updated to June 2023, aims to present the current available evidence on the role of gastroenterologists in the diagnosis and treatment of both local and systemic complications by either endoscopic or medical treatments.

Expert opinion

At diagnosis and during chronic pancreatitis follow-up, particular care is needed to consider not only the clinically manifest signs and symptoms of the disease, such as pain, jaundice, gastrointestinal obstruction, and pseudocysts, which require multidisciplinary discussion to establish the best treatment option (endoscopic or surgical), but also less evident systemic complications. Pancreatic exocrine and endocrine insufficiency, together with chronic inflammation, addiction, and dysbiosis, contribute to malnutrition, sarcopenia, and osteopathy. These complications, in turn, increase the risk of infection, thromboembolic events, and death. Patients with chronic pancreatitis also have an increased risk of psychiatric disorders and pancreatic cancer onset. Overall, patients with chronic pancreatitis should receive a holistic evaluation, considering all these aspects, possibly through multidisciplinary care in dedicated expert centers.

KEYWORDS:

• Chronic pancreatitis
• complications
• endoscopy
• pancreatic function
• malnutrition
• osteopathy
• death
• pancreatic cancer

Article highlights

• Chronic Pancreatitis (CP) is a heterogeneous and progressive disease that represents the end-stage of an inflammation-to-fibrosis process.

• Pain is the cardinal symptom, but the disease is also characterized by complications associated with both structural damage to the organ and functional impairment of the pancreas.

• The correlation between morphology and function is limited, and gastroenterologists need to be aware of both aspects.

• Morphological complications include obstruction of the main pancreatic duct, which can cause pain. Both endoscopic and surgical treatments are available, with the latter being more effective. Endoscopic treatment is the first-line option for jaundice caused by benign stenosis and for draining pseudocysts. It can also be considered for gastric outlet obstruction in individuals who are not suitable candidates for surgery or as a bridge to surgery.

• Pancreatic exocrine insufficiency, along with other factors, contributes to malnutrition, which in turn leads to sarcopenia and osteopathy. This condition also increases the risk of extra-pancreatic complications, hospitalization, and death.

• CP patients have an increased risk of death due to infections, thromboembolic events, suicide, and a higher risk of developing pancreatic cancer.

• It is crucial for gastroenterologists to consider all of these aspects when treating patients with CP from a holistic perspective. This may be best achieved in a dedicated center with a multidisciplinary approach.

Declaration of interests

G Capurso has participated as a clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Viatris and Bayer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.