Chronic pancreatitis: pathogenesis, natural history and conservative treatment.

Chronic pancreatitis is a serious disease with high morbidity and high mortality. It mostly affects young adults and specifically people with long-term alcohol intake. The diagnosis must be suspected in patients with abdominal pain of unknown origin and in patients with diarrhoea and/or weight loss, particularly if they regularly use alcohol or present with a mild diabetes developed after the age of 30 years. Fundamental problems, such as the aetio-pathogenesis and the mechanism for the abdominal pain, are still unanswered. Contradictory observations concerning the natural history have been reported and further studies are needed to characterize the long-term course of symptoms and complications. The long-term management of patients requires careful attention to medical abuse and to complications (pseudocysts, duodenal ulcer, overt diabetes, and exocrine insufficiency). The high risk for malignant diseases also has to be taken into consideration.