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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.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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
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.

Keywords: Pancreatitis, chronic, Diagnosis, Exocrine pancreatic insufficiency, Pancreatic enzyme replacement therapy, Malabsorption

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.