Chronic Tropical Pancreatitis: Clinical Syndromes, Natural Course Management Principles

This chapter presents an update on the distinct entity of tropical chronic pancreatitis (TCP), a calcifying, nonalcoholic, chronic pancreatitis. Recent reports on the pathogenesis of this disease, which generally afflicts younger, poorly nourished individuals, have focused on genetic mutations of cathepsin B, chymotrypsin C, and SPINK1. The disease progresses through the stages of abdominal pain followed by exocrine insufficiency, with diabetes possibly heralding a late stage of the disease. The risk of pancreatic cancer in these patients is perceived to be higher than in patients with chronic pancreatitis of other etiologies. Medical management revolves around treating the symptoms of pain and of exocrine and endocrine insufficiency. Endoscopy has been used for isolated pancreatic ductal strictures and for control of pain due to ductal obstruction secondary to strictures and/or stones, with good short-term relief. Surgery is aimed at decompressing either the dilated pancreatic ductal system with removal of calculi to afford relief from intractable pain or an obstructed biliary or digestive system, or to resect a portion of the pancreas that is suspected of harboring a malignant change. Surgery is the only treatment option for pain in TCP with the potential of long-term relief.