Gastroenterology and hepatology
Chronic pancreatitis and exocrine insufficiency
Causes by TIGAR-O, CT then EUS or secretin MRCP for diagnosis, faecal elastase and pancreatic enzyme dosing, pain management and the ESCAPE trial, type 3c diabetes, and the complications that need surveillance.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Progressive inflammation and fibrosis of the pancreas, ending in pain, exocrine insufficiency, diabetes and an increased risk of pancreatic cancer.
- Alcohol and smoking cause most adult cases. Recurrent acute pancreatitis often precedes it (see Acute pancreatitis).
- Diagnose on imaging: CT first, then EUS or secretin-enhanced MRCP. Lipase is often normal.
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Sources
- Gardner TB et al. ACG Clinical Guideline: Chronic Pancreatitis. Am J Gastroenterol 2020;115:322-39American College of Gastroenterology, 2020
- Whitcomb DC et al. AGA Clinical Practice Update on the Epidemiology, Evaluation, and Management of Exocrine Pancreatic Insufficiency: Expert Review. Gastroenterology 2023;165:1292-301American Gastroenterological Association, 2023
- American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis: summary and recommendations. Gastrointest Endosc 2024;100:584-94American Society for Gastrointestinal Endoscopy, 2024
- ESPEN practical guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr 2024;43:395-412European Society for Clinical Nutrition and Metabolism, 2024
- Issa Y et al. Effect of early surgery vs endoscopy-first approach on pain in patients with chronic pancreatitis (ESCAPE). JAMA 2020;323:237-47JAMA, 2020
- Therapeutic Guidelines: Gastrointestinal (eTG complete), chronic pancreatitis and pancreatic exocrine insufficiencyAU/NZTherapeutic Guidelines Limited, current eTG edition (version not verified)
- Rebours V et al. Risk of pancreatic adenocarcinoma in patients with hereditary pancreatitis: a national exhaustive series. Am J Gastroenterol 2008;103:111-9American Journal of Gastroenterology, 2008
- Shelton CA et al. Hereditary pancreatitis in the United States: survival and rates of pancreatic cancer. Am J Gastroenterol 2018;113:1376American Journal of Gastroenterology, 2018
- Last updated
- 14 November 2026
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