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Diagnostik und Standards der konservativen Therapie bei chronischer Pankreatitis

Diagnosis and standards of conservative treatment in chronic pancreatitis

  • Themenschwerpunk: Neue Aspekte in Diagnose und Therapie der Chronischen Pankreatitis
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Grundlagen

Die chronische Pankreatitis (cP) mit dem Leitsymptom des heftigen intermittierenden oder chronischen Oberbauchschmerzes ist zu 90% in industrialisierten Ländern ätiologisch durch einen chronischen Alkoholabusus bedingt.

Methodik

Die Diagnostik und Standards der konservativen Therapie bei cP werden in einer Übersicht dargestellt.

Ergebnisse

Neben dem klinischen Bild der cP basiert die Diagnostik zunächst auf bildgebenden Verfahren wie Sonographie, Computertomographie und insbesondere endoskopisch retrograde Pankreatikographie (ERP). Zur diagnostischen Evaluierung einer bestehenden exokrinen Pankreasinsuffizienz mit dem klinischen Bild des Gewichtsverlustes und Steatorrhoe dienen nicht-invasive und invasive Funktionsuntersuchungen. Die Therapie der Schmerzen bei cP gestaltet sich zunächst konservativ. Eine strikte Alkoholkarenz stellt den dietätischen Grundstein der günstigen Beeinflussung dar. Darüber hinaus werden in der Schmerztherapie neben einer symptomatisch analgetischen Behandlung auch Pankreasenzyme eingesetzt, die die endogene Pankreasstimulation durch einen negativen feed-back-Mechanismus hemmen sollen. Die exokrine Pankreasinsuffizienz wird durch die Gabe von Pankreasenzymen behandelt, wobei eine ausreichende Menge Lipase den wichtigsten Substitutionsfaktor darstellt. Es werden mindestens 40.000 IE Lipase zu normalen Mahlzeiten empfohlen. Darreichungsform und-menge sollten jedoch im Einzelfall angepaßt werden.

Schlu\folgerungen

Bei cP ist ein systematisches und individuell angepa\tes therapeutisches Vorgehen notwendig, was insbesondere beim Vorliegen von Sekundärkomplikationen einen interdisziplinären therapeutischen Ansatz nach sich ziehen kann.

Summary

Background

The main clinical symptom of chronic pancreatitis (cp) is upper abdominal pain, and in 90% chronic alcohol abuse is the etiological factor especially in industrialized countries.

Methods

The diagnosis and standards of conservative treatment in chronic pancreatitis are reviewed.

Results

Beside the typical clinical picture of the disease diagnosis is based on imaging procedures to visualize the pancreas including ultrasonography, computed tomography and endoscopic retrograde pancreatography (ERP). Diagnostic evaluation of pancreatic insuffiency accompanied by the clinical picture of weight loss and steatorrhea is completed by noninvasive and invasive function tests. Therapy of chronic pain in cp is usually based on conservative treatment. A strict alcohol abstinence is the first dietetic measure in the management of pain. Further steps are a symptomatic analgetic treatment, and administration of pancreatic enzymes, which are able to inhibit pancreatic secretion via negative feed back mechanisms. Exocrine pancreatic insuffiency is treated by dietetic measures together with an adequate pancreatic enzyme substitution, whereas lipase activity is the most important factor. A sufficient lipase substitution requires at least 40.000 IE given together with the meals. Attention must be directed to dose and preparation of pancreatic enzymes being used.

Conclusions

The principle treatment of cp should be adjusted individually and requires a systematic approach. Complications of cp and their treatment should be discussed in an interdisciplinary way of thinking including surgical interventions.

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Authors and Affiliations

  1. Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität Magdeburg, Leipziger Straße 44, D-39120, Magdeburg, Deutschland

    Ulrike von Arnim, J. E. Dominguez-Muñoz &  P. Malfertheiner

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  1. Ulrike von Arnim
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  2. J. E. Dominguez-Muñoz
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  3. P. Malfertheiner
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von Arnim, U., Dominguez-Muñoz, J.E. & Malfertheiner, P. Diagnostik und Standards der konservativen Therapie bei chronischer Pankreatitis. Acta Chir Austriaca 28, 217–222 (1996). https://doi.org/10.1007/BF02626008

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