CT or MRI is recommended for first-line diagnosis of chronic pancreatitis, whereas endoscopic ultrasonography, because of its invasiveness and lack of specificity, should be used only if the diagnosis is in question after cross-sectional imaging, according to a recent guideline from the American College of Gastroenterology.
Following cross-sectional imaging or endoscopic ultrasonography, the guideline suggested using secretin-enhanced magnetic resonance cholangiopancreatography when the diagnosis of chronic pancreatitis is not confirmed and the clinical suspicion remains high. Histological examination is suggested as the gold standard to diagnose chronic pancreatitis in high-risk patients when the clinical and functional evidence is strong but imaging is inconclusive, the guideline said. Genetic testing is recommended in patients with clinical evidence of a pancreatitis-associated disorder or possible chronic pancreatitis with unclear etiology, especially younger patients.
For management of pain, surgical intervention is recommended over endoscopic therapy in patients with obstructive disease if first-line endoscopic approaches have been exhausted or unsuccessful. The guideline suggested considering antioxidant therapy for pain even though the benefits of pain reduction are probably limited. The guideline did not suggest the use of pancreatic enzyme supplements for pain.
The guideline, which was based on a systematic review of the literature, also provides a list of key concepts and two diagnostic algorithms. It was published in the March American Journal of Gastroenterology and is available online.