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    Chronic Pancreatitis (beta)

    Official guideline from the American College of Gastroenterology.

    Strength
    Strong recommendation
    Conditional recommendation
    Evidence
    Moderate quality evidence
    Low quality evidence
    Very low quality evidence

    Diagnosis

    Diagnosis
    1. We recommend CT or MRI for the first-line diagnosis of CP. Either test should be the first choice for the diagnosis of CP. EUS, because of its invasiveness and lack of specificity, should be used only if the diagnosis is in question after cross-sectional imaging is performed.
    2. We suggest performing s-MRCP when the diagnosis of CP following cross-sectional imaging or EUS is not confirmed and the clinical suspicion remains high.
    3. We suggest histological examination as the gold standard to diagnose CP in high-risk patients when the clinical and functional evidence of CP is strong, but imaging modalities are inconclusive.

    Etiology

    Etiology
    1. We recommend genetic testing in patients with clinical evidence of a pancreatitis-associated disorder or possible CP in which the etiology is unclear, especially in younger patients.

    Management

    Natural History and Clinical Symptoms
    1. We recommend alcohol cessation in patients with CP.
    2. We recommend smoking cessation in patients with CP.
    Management of Pain
    1. We recommend surgical intervention over endoscopic therapy in patients with obstructive CP for the long-term relief of pain if first-line endoscopic approaches to pancreatic drainage have been exhausted or unsuccessful.
    2. We suggest considering the use of antioxidant therapy for CP with pain, although the benefit of pain reduction is likely limited.
    3. We do not suggest the use of pancreatic enzyme supplements to improve pain in CP.
    4. We suggest considering celiac plexus block for treatment of pain in CP.
    Management of Exocrine Pancreatic Insufficiency
    1. We suggest PERT in patients with CP and exocrine pancreatic insufficiency to improve the complications of malnutrition.
    What do the icons mean?  
    Research PaperGardner TB, Adler DG, Forsmark CE, Sauer BG, Taylor JR, Whitcomb DC. Acg clinical guideline: chronic pancreatitis. Am J Gastroenterol. 2020;115(3):322-339.