Gå direkt till huvudinnehållet

Pankreatit, kronisk

Senast uppdaterad: Senast reviderad:
Sakkunnig:


Definition:
Kronisk inflammation som leder till kvarstående skada av pankreas.
Förekomst:
I Europa är prevalensen är 120/100 000 personer och incidensen är 5–10/100 000 personår.
Symtom:
Kroniska eller recidiverande magsmärtor, ibland måltidsrelaterade, viktnedgång och något mer sällan steatorré och symtom som vid diabetes mellitus.
Kliniska fynd:
Tecken till undernäring vid exokrin svikt. Ömhet vid bukpalpation. Eventuellt fynd som överensstämmer med långvarigt högt alkoholintag.
Diagnostik:
Minskat P/S-amylas eller P/S-lipas kan förekomma. Typiska fynd vid medicinsk bilddiagnostik där DT-undersökning i flera kontrastfaser (pankreasprotokoll) är förstahandsmetod. 
Behandling:
Upphöra med, eller kraftigt minska intag av, alkohol. Rökstopp. Smärtlindring, pankreasenzymer (vid exokrin pankreas svikt), diabetesbehandling (vid endokrin pankreassvikt) och näringstillskott om malnutrition föreligger. I vissa fall är endoskopiska och kirurgiska åtgärder indicerade.
  1. Regnér S, Matthias Löhr J. Nya riktlinjer för kronisk pankreatit. Lakartidningen.se 2020-03-20 lakartidningen.se  
  2. Löhr JM, Dominguez-Munoz E, Rosendahl J, et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J. 2017;5(2):153–199. PMID: 28344786 PubMed  
  3. Nair RJ, Lawler L. Chronic pancreatitis. Am Fam Physician 2007; 76: 1679-88. PubMed  
  4. Lin Y, Tamakoshi A, Matsuno S, Takeda K, Hayakawa T, Kitagawa M, et al. Nationwide epidemiological survey of chronic pancreatitis in Japan. J Gastroenterol 2000; 35: 136-41. PubMed  
  5. Chen WX, Zhang WF, Li B, Lin HJ, Zhang X, Chen HT, et al. Clinical manifestations of patients with chronic pancreatitis. Hepatobiliary Pancreat Dis Int 2006; 5: 133-7. PubMed  
  6. Yadav D, Hawes RH, Brand RE et al. Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis. Arch Intern Med. 2009 Jun 8;169(11):1035-45. PMID: 19506173 PubMed  
  7. Rebours V, Vullierme MP, Hentic O et al. Smoking and the course of recurrent acute and chronic alcoholic pancreatitis: a dose-dependent relationship. Pancreas. 2012 Nov;41(8):1219-24. PMID: 23086245 PubMed  
  8. Finkelberg DL, Sahani D, Deshpande V, Brugge WR. Autoimmune pancreatitis. N Engl J Med 2006; 355: 2670-6. New England Journal of Medicine  
  9. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 2001; 120: 682-707. Gastroenterology  
  10. Keiles S, Kammesheidt A. Identification of CFTR, PRSS1, and SPINK1 mutations in 381 patients with pancreatitis. Pancreas 2006; 33: 221-7. PubMed  
  11. Ahmad SA, Wray C, Rilo HL, Choe KA, Gelrud A, Howington JA, et al. Chronic pancreatitis: recent advances and ongoing challenges. Curr Probl Surg 2006; 43: 127-238. PubMed  
  12. Cohn JA, Friedman KJ, Noone PG, Knowles MR, Silverman LM, Jowell PS. Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis. N Engl J Med 1998; 339: 653-58. New England Journal of Medicine  
  13. Schneider A, Whitcomb DC. Hereditary pancreatitis: a model for inflammatory diseases of the pancreas. Best Pract Res Clin Gastroenterol 2002; 16: 347-63. PubMed  
  14. Stevens T, Conwell DL, Zuccaro G. Pathogenesis of chronic pancreatitis: an evidence-based review of past theories and recent developments. Am J Gastroenterol 2004; 99: 2256-70. PubMed  
  15. DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme ouputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 1973; 288: 813-15. New England Journal of Medicine  
  16. Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis: pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion 1993; 54: 148-55. PubMed  
  17. Majumder S, Chari ST. Chronic pancreatitis. Lancet. 2016 May 7;387(10031):1957-66. PMID: 26948434 PubMed  
  18. Hart PA, Krishna SG, Okazaki K. Diagnosis and Management of Autoimmune Pancreatitis. Curr Treat Options Gastroenterol. 2017 Dec;15(4):538-547. PMID: 28842855. PubMed  
  19. Masamune A, Nishimori I, Kikuta K et al. Randomised controlled trial of long-term maintenance corticosteroid therapy in patients with autoimmune pancreatitis. Gut. 2017 Mar;66(3):487-494. PMID: 27543430 PubMed  
  20. Kempeneers MA, Issa Y, Verdonk RC, et al . Pain patterns in chronic pancreatitis: A nationwide longitudinal cohort study. Gut 2021. pmid:33158979 PubMed  
  21. Ammann RW. The natural history of alcoholic chronic pancreatitis. Intern Med 2001; 40: 368-75. PubMed  
  22. Chase CW, Barker DE, Russell WL, Burns RP. Serum amylase and lipase in the evaluation of acute abdominal pain. Am Surg 1996; 62: 1028-33. PubMed  
  23. Munoz A, Katerndahl DA. Diagnosis and management of acute pancreatitis. Am Fam Physician 2000; 62: 164-74. American Family Physician  
  24. Remer EM, Baker ME. Imaging of chronic pancreatitis. Radiol Clin North Am 2002; 40: 1229-42. PubMed  
  25. Mitchell RMS, Byrne MF, Baillie J. Pancreatitis. Lancet 2003; 361: 1447-55. PubMed  
  26. Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, et al., for the Standards of Practice Committee of American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 2005; 62: 1-8. PubMed  
  27. Makary MA, Duncan MD, Harmon JW, Freeswick PD, Bender JS, Bohlman M, et al. The role of magnetic resonance cholangiography in the management of patients with gallstone pancreatitis. Ann Surg 2005; 241: 119-24. PubMed  
  28. Conwell DL, Lee LS, Yadav D, et al. American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: evidence-based report on diagnostic guidelines. Pancreas. 2014 Nov;43(8):1143-62. doi: 10.1097/MPA.0000000000000237. DOI  
  29. Lecesne R, Taourel P, Bret PM, Atri M, Reinhold C. Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome. Radiology 1999; 211: 727-35. Radiology  
  30. Nationell riktlinje – kronisk pankreatit. Svensk Gastroenterologisk Förening. 2018 svenskgastroenterologi.se  
  31. Olesen SS, Bouwense SA, Wilder-Smith OH, et al. Pregabalin reduces pain in patients with chronic pancreatitis in a randomized, controlled trial. Gastroenterology 2011; 141: 536-43. Gastroenterology  
  32. Vecht J, Symersky T, Lamers CB, Masclee AA. Efficacy of lower than standard doses of pancreatic enzyme supplementation therapy during acid inhibition in patients with pancreatic exocrine insufficiency. J Clin Gastroenterol 2006; 40: 721-5. PubMed  
  33. Haaber AB, Rosenfalck AM, Hansen B, Hilsted J, Larsen S. Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency. Int J Pancreatol 2000; 27: 21-7. PubMed  
  34. Diener MK, Hüttner FJ, Kieser M. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial. Lancet. 2017 Sep 9;390(10099):1027-1037. PMID: 28901935 PubMed  
  35. Bang UC, Benfield T, Hyldstrup L, et al. Mortality, cancer, and comorbidities associated with chronic pancreatitis: a Danish nationwide matched-cohort study. Gastroenterology. 2014 Apr;146(4):989-94. PubMed  
  36. Malka D, Hammel P, Sauvanet A, Rufat P, O'Toole D, Bardet P, et al. Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology 2000; 119: 1324-32. Gastroenterology  
  37. Thorsgaard Pedersen N, Nyboe Andersen B, Pedersen G et al. Chronic pancreatits in Copenhagen. Scand J Gastroenterol 1982; 17: 925-31. PubMed  
  38. Simon B, Printz H. Epidemiological trends in pancreatic neoplasias. Dig Dis 2001; 19: 6-14. PubMed  
  39. Hoogenboom SA, Lekkerkerker SJ, Fockens P. Systematic review and meta-analysis on the prevalence of vitamin D deficiency in patients with chronic pancreatitis. Pancreatology. 2016 Sep-Oct;16(5):800-6. PMID: 27453461 PubMed  
  40. Munigala S, Agarwal B, Gelrud A, Conwell DL. Chronic Pancreatitis and Fracture: A Retrospective, Population-Based Veterans Administration Study. Pancreas. 2016 Mar;45(3):355-61. PMID: 26199986 PubMed  
  • Jon Tsai, med dr och kirurg specialiserad inom övre gastro, Karolinska Institutet
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet