Chronic pancreatitis: current status and challenges for prevention and treatment

This article presents the results of modern epidemiological studies that emphasize the increasing prevalence of acute and chronic pancreatitis (CP) in many countries, as well as the high likelihood of developing secondary diabetes mellitus, pancreatic cancer. The risk factors for CP occurrence are listed, such as: alcohol, smoking, genetic predisposition, anatomical and obstructive disorders; pathogenetic mechanisms of CP development in the outcome of acute pancreatitis are considered. Attention is paid to laboratory instrumental diagnosis of CP, the advantages and disadvantages of transabdominal ultrasound, computed tomography and magnetic resonance imaging. The emphasis is made on the use of endoscopic ultrasound, diagnostic tests to evaluate exocrine pancreatic function (fecal elastase-1, trypsinogen, triglyceride breath test, cholecystokinin test). The role of correction of modifiable factors and the rejection of bad habits in the treatment of CP is noted. Modern pharmacotherapy regimens for CP with analgesics (starting with non-steroidal anti-inflammatory drugs), tricyclic antidepressants, pregabalin, enzyme replacement therapy, simvastatin are described. Surgical techniques for pain relief in CP (endoscopic decompression, shock wave lithotripsy, resection) are considered. The therapeutic techniques for preventing CP complications are described, and the expediency of conducting prolonged enzyme replacement therapy is emphasized. The problematic aspects of pancreatology are listed that need to be studied in future in order to improve outcomes and prognosis in patients with CP.