The practical implications of the new Marseilles classification (1984) of
pancreatitis are discussed and the present-day diagnostic methods critically reviewed. The new classification distinguishes between two typical long-term profiles, i.e. acute (reversible) and chronic (progressive)
pancreatitis. Modern diagnostic tests such as sonography, CT, ERCP and the
secretin-CCK test do not provide a "gold standard" for early
chronic pancreatitis. Thus, long-term studies of function and morphology are needed to differentiate
chronic pancreatitis (progressive dysfunction, calcification, ERP changes) from acute (reversible)
pancreatitis. The etiology is a helpful prognostic guide since
gallstone pancreatitis virtually never becomes chronic. However, alcoholic "
acute" pancreatitis may not always progress to
chronic pancreatitis.
Drug or surgical treatment of
pain is symptomatic and empirical, since the pathomechanisms of
pain are poorly understood. A prerequisite for optimum
therapy is exact staging of the disease into: uncomplicated early stages with short, self-limiting episodes of
pancreatitis:
conservative therapy, persistent
pain, mainly due to pseudocysts (diagnosis by morphological tests): surgical
therapy, advanced painless forms of
chronic pancreatitis associated with diabetes and/or
steatorrhea: diet and substitution
therapy. After successful surgical drainage persistent
pain subsides, but postoperative episodic recurrences of
pancreatitis are common in the early stages of the disease and in association with continued alcohol intake. However, spontaneous
pain relief occurs in all cases in the late stages of the disease and with progressive pancreatic dysfunction (despite continued
alcohol abuse).