Duggan SN, Ní Chonchubhair HM, Lawal O, O’Connor DB, Conlon KC. Chronic pancreatitis: A diagnostic dilemma. World J Gastroenterol 2016; 22(7): 2304-2313 [PMID: 26900292 DOI: 10.3748/wjg.v22.i7.2304]
Corresponding Author of This Article
Sinead N Duggan, PhD, Research Fellow, Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Centre for Pancreatico-Biliary Diseases, Trinity Centre for Health Sciences, Tallaght Hospital, 24 Dublin, Ireland. duggansi@tcd.ie
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
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World J Gastroenterol. Feb 21, 2016; 22(7): 2304-2313 Published online Feb 21, 2016. doi: 10.3748/wjg.v22.i7.2304
Chronic pancreatitis: A diagnostic dilemma
Sinead N Duggan, Hazel M Ní Chonchubhair, Oladapo Lawal, Donal B O’Connor, Kevin C Conlon
Sinead N Duggan, Hazel M Ní Chonchubhair, Oladapo Lawal, Donal B O’Connor, Kevin C Conlon, Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Centre for Pancreatico-Biliary Diseases, Trinity Centre for Health Sciences, Tallaght Hospital, 24 Dublin, Ireland
Author contributions: Duggan SN performed the literature search and review, developed the concepts, and wrote the manuscript; Ní Chonchubhair HM, Lawal O and O’Connor DB participated in drafting the paper and revised the manuscript critically; Conlon KC conceived the idea, participated in drafting the paper, revised the manuscript critically, and is guarantor of the paper.
Supported by an unrestricted educational grant from The Meath Foundation www.meathfoundation.com (in part, to Duggan SN); unrestricted research grant from Mylan (in part, to Ní Chonchubhair HM).
Conflict-of-interest statement: Duggan SN has received fees for serving as a speaker and/or writer for Mylan, Fresenius Kabi, Merck and Nutricia.
Correspondence to: Sinead N Duggan, PhD, Research Fellow, Professorial Surgical Unit, Department of Surgery, Trinity College Dublin, Centre for Pancreatico-Biliary Diseases, Trinity Centre for Health Sciences, Tallaght Hospital, 24 Dublin, Ireland. duggansi@tcd.ie
Telephone: +353-1-8963719 Fax: +353-1-8963788
Received: August 18, 2015 Peer-review started: August 19, 2015 First decision: October 14, 2015 Revised: October 23, 2015 Accepted: December 8, 2015 Article in press: December 8, 2015 Published online: February 21, 2016 Processing time: 165 Days and 12.9 Hours
Abstract
Typical clinical symptoms of chronic pancreatitis are vague and non-specific and therefore diagnostic tests are required, none of which provide absolute diagnostic certainly, especially in the early stages of disease. Recently-published guidelines bring much needed structure to the diagnostic work-up of patients with suspected chronic pancreatitis. In addition, novel diagnostic modalities bring promise for the future. The assessment and diagnosis of pancreatic exocrine insufficiency remains challenging and this review contests the accepted perspective that steatorrhea only occurs with > 90% destruction of the gland.
Core tip: Chronic pancreatitis presents a diagnostic challenge, especially in early disease. This paper summarizes the available diagnostic modalities as well as the most recently-published diagnostic guidelines. It is widely accepted that the pancreas has excellent exocrine reserve. We review the original studies which have supported this principle and suggest an alternative interpretation of the data.
