Chronic pancreatitis (CP) is historically defined as an irreversible inflammatory condition of the pancreas leading to varying degrees of exocrine and endocrine dysfunction. Recently however, the paradigm for the diagnosis has changed in that it breaks with the traditional clinicopathologic-based definition of disease, focusing instead on diagnosing the underlying pathologic process early in the disease course and managing the syndrome more holistically to change the natural course of disease and minimize adverse disease effects. Currently, the most accepted mechanistically derived definition of CP is a pathologic fibroinflammatory syndrome of the pancreas in individuals with genetic, environmental, and/or other risk factors who develop persistent pathologic responses to parenchymal injury or stress. The most common symptom of CP is abdominal pain, with other symptoms such as exocrine pancreatic insufficiency and diabetes developing at highly variable rates. CP is most commonly caused by toxins such as alcohol or tobacco use, genetic polymorphisms, and recurrent attacks of acute pancreatitis, although no history of acute pancreatitis is seen in many patients. Diagnosis is made usually on cross-sectional imaging, with modalities such as endoscopic ultrasonography and pancreatic function tests playing a secondary role. Total pancreatectomy represents the only known cure for CP, although difficulty in patient selection and the complications inherent to this intervention make it usually an unattractive option. This guideline will provide an evidence-based practical approach to the diagnosis and management of CP for the general gastroenterologist.

中文翻译：

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ACG临床指南

慢性胰腺炎 (CP) 在历史上被定义为一种不可逆的胰腺炎症，导致不同程度的外分泌和内分泌功能障碍。然而，最近，诊断范式发生了变化，它打破了传统的基于临床病理学的疾病定义，转而专注于在病程早期诊断潜在的病理过程，并更全面地管理综合征以改变疾病的自然病程并尽量减少不利的疾病影响。目前，最被接受的机械衍生的 CP 定义是具有遗传、环境和/或其他危险因素的个体的胰腺病理性纤维炎症综合征，这些因素对实质损伤或压力产生持续的病理反应。CP最常见的症状是腹痛，其他症状，如外分泌胰腺功能不全和糖尿病，以高度可变的速度发展。CP 最常见的是由酒精或烟草使用等毒素、基因多态性和急性胰腺炎的反复发作引起，尽管许多患者没有急性胰腺炎病史。诊断通常通过横断面成像进行，其中内窥镜超声检查和胰腺功能检查等方式起次要作用。全胰切除术是 CP 唯一已知的治愈方法，尽管患者选择困难和这种干预固有的并发症使其通常是一个没有吸引力的选择。本指南将为普通胃肠病学家提供一种基于证据的实用方法来诊断和管理 CP。