Medical treatment of chronic pancreatitis        LAI Ya-min,QIAN Jia-ming. Department of Gastroenterology, Chinese Academy of Medical Sciences, China Peking Union Medical College,Peking Union Medical College Hospital,  Beijing100730,China
Corresponding author：QIAN Jia-ming, E-mail qjiaming57@gmail.com
Abstract    Chronic pancreatitis (CP) is an ongoing in?amatory disorder characterized by irreversible destruction of the pancreas associated with disabling chronic pain and permanent loss of exocrine and endocrine function. The treatment of patients with CP revolves around control of pain, diabetes and steatorrhea. Pain relief is the most common and most difficult problem. The initial approach should consist of non-opioid analgesics and supplementation with pancreatic enzymes containing high amounts of proteases. Enzymes significantly reduce fat excretion and stool frequency and improve fat absorption. Dosing and timing are important. Although the medical treatment of CP is frustrating in most cases and the role of pancreatic enzyme replacement therapy and anti-oxidants is uncertain,the benefit of pancreatic endotherapy for CP is encouraging. The modalities include pancreatic sphincterotomy, stenting and ESWL to break large calculi. With growing expertise in endoscopic techniques, refinements in equipment and promising results from uncontrolled studies, patients should be offered opportunities of endoscopic therapy before subjecting them to surgical treatment. Both alcohol and smoking cessation are likely to be beneficial to CP patient. A low-fat diet may contribute to development of fat-soluble vitamin deficiencies and is an unnecessary intervention for treatment of steatorrhoea.