Department of Surgery, University of Cape Town, South Africa.
S Afr Med J. 2010 Dec 1;100(12 Pt 2):845-60. doi: 10.7196/samj.4530.
Chronic pancreatitis (CP) is defined as a continuing inflammatory disease of the pancreas characterised by irreversible morphological changes, often associated with pain and with the loss of exocrine and/or endocrine function that may be clinically relevant. Alcohol is the predominant cause of CP in the western world and is particularly prevalent in South Africa, especially in the indigent patient. CP ranks high among intractable diseases of the gastrointestinal tract. The tendency for substance abuse in the alcohol-induced group poses major psychological and socio-economic problems.
CP is a disease with significant clinical and pathological heterogeneity. Level 1 evidence to support definitive guidelines for diagnosis, medical management and interventional therapy is lacking. Despite this paucity of robust scientific evidence, it is important to provide some assistance based on the best available evidence as to the current standard of care for CP in the South African context; this will aid all involved in the management of the disease, and includes clinicians, health care managers and funders.
The guidelines were developed as recommendations addressing the diagnosis, medical management and interventions, both endoscopic and surgical, for the management of a very complex and heterogeneous disease of the pancreas. The recommendations are particularly relevant in the South African context where the predominant patho-aetiological agents are alcohol-associated with smoking.
The guidelines provide clear recommendations regarding the diagnostic modalities available, both imaging (which includes MRI and endoscopic ultrasound (EUS)) and pancreatic function tests. The section on medical management makes recommendations on the use of analgesics, enzyme replacement and other therapeutic options in the non-interventional management of the majority of patients with CP. The section on interventional procedures identifies the indications and options available for the interventional management of both uncomplicated and complicated CP. The role of endoscopic and surgical modalities is defined, but it is in this context especially that the best available evidence, combined with the experience of the group, influenced the recommendations put forward. Owing to the lack of evidence and the complexity of the disease, it is recommended that, where possible, CP is managed in the context of a multidisciplinary team.
The guidelines are based on best practice principles determined by the available evidence and the opinions of the group, which comprised 7 medical and surgical gastroenterologists with significant experience in dealing with patients with chronic pancreatitis in the South African context. The group convened between May 2009 and August 2010 under the auspices of the Hepato-Pancreatico-Biliary Association of South Africa (HPBASA) and the South African Gastroenterology Society (SAGES), and the guidelines are the result of broad consensus within this group. The draft was presented to other experts in this field of endeavour to ensure broader participation and consensus. PLANS FOR GUIDELINE REVISION: HPBASA and SAGES will publish a revised modification of the recommendations when new levels 1 and 2 evidence data are published.
慢性胰腺炎（CP）被定义为一种持续的胰腺炎症性疾病，其特征为不可逆的形态学改变，常伴有疼痛，并伴有外分泌和/或内分泌功能丧失，这可能具有临床相关性。在西方世界，酒精是 CP 的主要病因，在南非尤其普遍，尤其是在贫困患者中。CP 在胃肠道难治性疾病中排名很高。酒精诱导组中物质滥用的倾向带来了重大的心理和社会经济问题。
CP 是一种具有显著临床和病理异质性的疾病。缺乏支持明确诊断、医学管理和介入治疗的一级证据。尽管缺乏强有力的科学证据，但根据目前南非 CP 护理的最佳可用证据提供一些帮助非常重要；这将有助于管理该疾病的所有相关人员，包括临床医生、医疗保健管理人员和资金提供者。
该指南作为建议制定，旨在解决诊断、医学管理和干预措施，包括内镜和手术，用于管理胰腺的一种非常复杂和异质的疾病。这些建议在南非特别相关，因为主要的病理病因是与吸烟相关的酒精。
该指南就现有的诊断方式提供了明确的建议，包括影像学（包括 MRI 和内镜超声（EUS））和胰腺功能检查。医学管理部分就非介入性管理大多数 CP 患者的镇痛剂、酶替代和其他治疗选择提出了建议。介入程序部分确定了用于治疗简单和复杂 CP 的介入管理的适应证和选择。定义了内镜和手术方式的作用，但正是在这种情况下，结合小组的经验，最佳可用证据影响了提出的建议。由于缺乏证据和疾病的复杂性，建议尽可能在多学科团队的环境中管理 CP。
该指南基于最佳实践原则，由现有证据和小组意见确定，该小组由 7 名具有处理南非 CP 患者丰富经验的医学和外科胃肠病学家组成。该小组于 2009 年 5 月至 2010 年 8 月在南非肝胆胰协会（HPBASA）和南非胃肠病学会（SAGES）的主持下召开会议，该指南是该小组广泛共识的结果。该草案提交给该领域的其他专家，以确保更广泛的参与和共识。指南修订计划：当有新的 1 级和 2 级证据数据发布时，HPBASA 和 SAGES 将发布该建议的修订版本。
