Pancreatitis, Chronic
Description General Measures Medicine Treatment Referral ICD-10 code: K86.0-3/K86.8-9 DESCRIPTION Chronic inflammatory condition of the pancreas with severe abdominal pain, which results in functional and structural damage. In most patients, this is a chronic, progressive disease that leads to exocrine and/or endocrine insufficiency. GENERAL MEASURES Abstinence from alcohol reduces abdominal pain
ICD-10 code: K86.0-3/K86.8-9
DESCRIPTION
Chronic inflammatory condition of the pancreas with severe abdominal pain, which results in functional and structural damage. In most patients, this is a chronic, progressive disease that leads to exocrine and/or endocrine insufficiency.
GENERAL MEASURES
- Abstinence from alcohol reduces abdominal pain in the early stages of the disease.
- Stop smoking.
- Small frequent meals and restricted fat intake reduces pancreatic secretion and pain.
- When weight loss is not responding to exogenous enzymes and diet, consider supplementation with medium chain triglycerides.
- There is a risk of developing cancer of the pancreas. Consider this in patients who develop worsening pain, new onset diabetes or deterioration in exocrine function.
- Dietary advice by dietician.
MEDICINE TREATMENT
Treatment is aimed at:
- pain,
- exocrine dysfunction (malabsorption, and diarrhoea)
- endocrine function. See Type 1 Diabetes mellitus.
Analgesia
See Pain, chronic.
Note:
Pancreatic enzymes may reduce pain by negative feedback on pancreatic secretion.
Malabsorption
Supplementation of fat-soluble vitamins may be indicated.
- Pancreatic enzyme replacement e.g. Lipase, oral, equivalent to lipase 30 000 units per day, in divided doses with meals and/or snacks.
- Titrate pancreatic enzyme replacement therapy until symptom control has been achieved.
REFERRAL
- Presence of pseudocyst for surgical intervention.
- Autoimmune chronic pancreatitis.
Click here for the NEMLC Recommendations for medicine treatement (2020-4 review cycle).
Standard Treatment Guidelines And Essential Medicines List For South Africa, Adult Hospital level, 2020-4_Version 1_July 2024
Chapter 1: Alimentary tract; 1.1 Gastrointestinal Disorders; 1.1.7 Pancreatitis, Chronic