Chronische Pankreatitis: Update Diagnostik und Therapie

Zusammenfassung

Hintergrund Die chronische Pankreatitis (CP) ist eine häufige Ursache für stationäre Einweisungen in die Gastroenterologie und ist mit einer reduzierten Lebensqualität und Lebenserwartung assoziiert. Die Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS) hat in der aktuellen S3-Leitlinie „Pankreatitis“ die neuesten Erkenntnisse von Epidemiologie, Diagnostik und Behandlung der akuten und chronischen Pankreatitis zusammengefasst. Hier werden praxisrelevante Aspekte für die chronische Pankreatitis zusammengefasst.

Ergebnisse Die häufigste Ursache der CP ist der chronische Alkoholabusus. Weitere Ursachen sind die hereditäre Pankreatitis, die Autoimmunpankreatitis, ein Hyperparathyreoidismus und idiopathische Formen der CP. Neben der klassischen hereditären Pankreatitis (PRSS1-Mutation), sind in den letzten Jahren eine Vielzahl an Genen identifiziert worden, die mit einem erhöhten Risiko für die Entwicklung einer idiopathischen CP assoziiert sind. In der konservativen Therapie der CP steht die Behandlung der exokrinen und endokrinen Insuffizienz sowie die Prävention und Behandlung von Sekundärkomplikationen (z.B. Osteoporose, Vitaminmangel, Mangelernährung) im Vordergrund. Lokale Komplikationen (Gallengangsstenose, Duodenalstenose, Pseudozysten und chronische Schmerzen) sollten in Pankreaszentren im interdisziplinären Konsens zwischen Viszeralchirurgie, Radiologie und der interventionellen Endoskopie abgestimmt werden. Während die Drainage von Pseudozysten die Domäne der Endoskopie ist, zeigen neueste Daten, dass die chirurgische Therapie von opiatabhängigen Schmerzen bei Patienten mit einem erweiterten Pankreasgang der Endoskopie überlegen ist.

Schlussfolgerung Die CP weist eine erhöhte Morbidität und Mortalität auf und führt häufig zu stationären Krankenhauseinweisungen. Das klinische Management dieser Patienten verlangt ein hohes Maß an Interdisziplinarität, um für jeden Patienten abhängig von den Komorbiditäten und dem Erkrankungsstadium ein individualisiertes Vorsorge- und Therapiekonzept zu entwerfen.

Abstract

Introduction Chronic pancreatitis (CP) is a frequent cause for hospitalization and is associated with impaired quality of life and reduced overall survival. The German Society for Gastroenterology (DGVS) has recently completed the S3-Guideline “Pancreatitis” that summarizes key findings on epidemiology, diagnostic and therapeutic concepts for acute and chronic pancreatitis. Here, we recapitulate the most relevant findings for clinicians regarding CP.

Results The most common cause of CP is chronic alcohol abuse, other causes are hereditary pancreatitis, autoimmune pancreatitis, hyperparathyroidism and idiopathic forms. Apart from the classical hereditary pancreatitis (PRSS1 mutation), a number of genetic associations have been discovered over the last years that are associated with an increased risk to develop idiopathic CP. The conservative management of CP is focused on the appropriate management of exocrine and endocrine insufficiency, and the prevention and treatment of secondary complications such as osteoporosis, vitamin deficiencies and malnutrition. Local complications (bile duct stenosis, duodenal stenosis, pseudocysts and chronic pain) should be managed in multidisciplinary teams in specialized pancreas centres with expert surgeons, radiologists and gastroenterologists. Infected or symptomatic pseudocysts should be primarily addressed by endoscopic drainage. In contrast, patients with chronic pain, dilated pancreas duct and opioid use should be considered for early surgical intervention.

Conclusion Chronic pancreatitis is associated with increased morbidity and mortality and often leads to hospital admissions. The clinical management of complex patients with local complications requires an interdisciplinary approach to tailor available therapeutic modalities depending on the stage of the disease and pre-existing comorbidities.

Schlüsselwörter

Chronische Pankreatitis - chronische Schmerzen - S3 Leitlinie - exokrine Insuffizienz - Gallengangsstenose - Pseudozyste

Keywords

chronic pancreatitis - chronic pain - S3 guideline - exocrine insufficiency - biliary stenosis - pseudocyst

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