Diagnosis of chronic pancreatitis

Chronic pancreatitis (CP) is usually a progressive condition, histologically characterized by inflammatory mainly lymphocytic infiltration, focal necrosis, fibrosis, and intraductal calcifications. In an advanced stage, destruction of the exocrine and endocrine pancreatic tissue leads to maldigestion and diabetes mellitus. Although histology is the “gold standard” for the diagnosis of CP, in clinical practice pancreatic tissue is obtained only during surgery for therapy of CP and is therefore not available for initial diagnostic workup. Noninvasive imaging methods are the tools of choice for supporting the diagnosis of CP in clinical routine. Sensitivity and specificity of different imaging methods vary significantly and are dependent on the stage of the disease and the operator’s experience. Endoscopic retrograde cholangiopancreatography (ERCP) is still the gold standard among all imaging methods, but in the near future magnetic resonance cholangiography may replace ERCP. In patients presenting with chronic abdominal pain and alcohol abuse of many years, diagnosis of CP is usually easily made by pathognomonic findings in imaging. The challenge is to correctly diagnose patients with CP in earlier stages of the disease. In early stages of CP, morphologic examinations and function tests can be helpful to establish the diagnosis.