Jan Trna, Oldřich Stibůrek, Marcela Shánělová, Petr Dítě
Abdominal pain, exocrine and endocrine insufficiency are the most common symptoms of chronic pancreatitis. Conservative
treatment options involve lifestyle modification, pancreatic enzyme substitution and analgesics. Adjunctive
agents such as antidepressants, GABA analogues (gabapentin, pregabalin) and proton-pump inhibitors can alleviate
disease symptoms. Small bowel bacterial overgrowth is treatable with antibiotics, preferably poorly absorbed rifaximin.
Diabetes mellitus can be treated with oral hypoglycaemics or insulin depending on residual pancreatic endocrine
function. Complicated cases require invasive treatment – radiological, endoscopic or surgical. Indications of surgery for
chronic pancreatitis are intractable pain, symptomatic complications (pseudocyst, pseudoaneurysm, obstruction of adjacent
structures) and doubt of malignancy.