The diagnosis of chronic pancreatitis involves a combination of clinical assessment, imaging studies, and sometimes histological examination.
Clinical assessment
- A comprehensive review of all risk factors in patients with clinical features of chronic pancreatitis is recommended to provide information on the underlying mechanisms, identify both fixed and modifiable risk factors, identify potential targets for therapies, and provide clinically relevant prognostic information
- The development of diabetes mellitus in chronic pancreatitis is most likely related to the disease duration, although other etiologic factors such as BMI and smoking status may incur an increased risk
- Pain assessment in chronic pancreatitis should follow the guidelines for other types of chronic pain, taking into account the multidimensional nature of symptom presentation
Imaging studies
- Cross-sectional imaging, such as CT or MRI, is recommended as the first-line imaging for the diagnosis of chronic pancreatitis
- Endoscopic ultrasound (EUS) can be considered for the diagnosis of chronic pancreatitis or early chronic pancreatitis due to its ability to provide detailed observation of the pancreatic parenchyma and the morphology of the pancreatic duct
- Abdominal MRI/MRCP can also be considered for the diagnosis of chronic pancreatitis
Histological examination
- Histological examination is considered the gold standard for the diagnosis of chronic pancreatitis in high-risk patients when the clinical and functional evidence of chronic pancreatitis is strong but imaging modalities are inconclusive
Pancreatic function testing
- Pancreatic function testing is recommended for the diagnosis of exocrine pancreatic insufficiency as a complementary means for the diagnosis of chronic pancreatitis
Differential diagnosis
- It is important to identify underlying disorders of pancreatic inflammation to predict progression to chronic pancreatitis
In conclusion, the diagnosis of chronic pancreatitis involves a combination of clinical assessment, imaging studies, and sometimes histological examination. It is important to consider the patient's clinical presentation, risk factors, and the results of diagnostic investigations in making a diagnosis.