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Evidence-based clinical practice guidelines for chronic pancreatitis 2021

JSGE · 2022 · Japan

Source and licence

Authors
Kyoko Shimizu, Tetsuhide Ito, Atsushi Irisawa et al.
Title
Evidence-based clinical practice guidelines for chronic pancreatitis 2021
Journal
Journal of Gastroenterology, 2022
DOI
10.1007/s00535-022-01911-6
Licence
CC BY 4.0
Changes
Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC9522716

Licence statement of the original publication

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

Open the original publication →Full text on Europe PMC

Recommendations

We found no explicitly labelled recommendations in this publication; its recommendations are in the running text of the original.

Abstract

Background: Chronic pancreatitis (CP) is defined according to the recently proposed mechanistic definition as a pathological fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental, and/or other risk factors who develop persistent pathological responses to parenchymal injury or stress.

Methods: The clinical practice guidelines for CP in Japan were revised in 2021 based on the 2019 Japanese clinical diagnostic criteria for CP, which incorporate the concept of a pathogenic fibro-inflammatory syndrome in the pancreas. In this third edition, clinical questions are reclassified into clinical questions, background questions, and future research questions.

Results: Based on analysis of newly accumulated evidence, the strength of evidence and recommendations for each clinical question is described in terms of treatment selection, lifestyle guidance, pain control, treatment of exocrine and endocrine insufficiency, and treatment of complications. A flowchart outlining indications, treatment selection, and policies for cases in which treatment is ineffective is provided. For pain control, pharmacological treatment and the indications and timing for endoscopic and surgical treatment have been updated in the revised edition.

Conclusions: These updated guidelines provide clinicians with useful information to assist in the diagnosis and treatment of CP.

Contents of the original publication

The section headings of the original.

  • Introduction
  • Definition
  • Diagnosis
  • CQ: is abdominal magnetic resonance imaging/MRCP recommended for diagnosis of CP?
  • CQ: is endoscopic ultrasound recommended for diagnosis of CP?
  • Etiology
  • FRQ: which patients should be tested for pancreatitis-associated genetic abnormalities?
  • Staging
  • Treatment
  • CQ: is smoking cessation guidance recommended for treatment of CP?
  • CQ: are nonopioid analgesics, opioids, and analgesic adjuvants recommended for treatment of pain?
  • CQ: is pancreatic enzyme replacement therapy recommended for treatment of pain?
  • CQ: are proteolytic enzyme inhibitors recommended for treatment of pain?
  • CQ: is long-term repeated endoscopic treatment recommended for treatment of pain?
  • CQ: is surgical treatment recommended for treatment of pain when endoscopic treatment is ineffective?
  • CQ: is a fat-restricted diet recommended for treatment of pancreatic exocrine insufficiency?
  • CQ: is pancrelipase recommended for treatment of pancreatic exocrine insufficiency?
  • CQ: are agents that suppress gastric acid recommended for treatment of pancreatic exocrine insufficiency?
  • CQ: is calorie restriction similar to that used in primary diabetes recommended when pancreatic exocrine insufficiency is complicated by diabetes?
  • CQ: are oral hypoglycemic agents recommended for treatment of diabetes secondary to CP?
  • CQ: is insulin therapy recommended for treatment of pancreatogenic diabetes mellitus?
  • CQ: is drainage recommended for pseudocysts associated with CP?
  • CQ: is a pancreatic duct stent recommended for internal pancreatic fistula?
  • CQ: is a bile duct stent recommended for biliary stricture associated with CP?
  • Prognosis
  • CQ: is endoscopic treatment (+ ESWL) recommended for patients with asymptomatic CP?
  • CQ: is surgery recommended to prevent progression of CP?

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