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Diagnostik und Therapie der chronischen Pankreatitis

Diagnosis and treatment of chronic pancreatitis

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Zusammenfassung

Die chronische Pankreatitis ist definiert als schubweise verlaufende Entzündung mit nachfolgendem Verlust der exokrinen und endokrinen Funktion des Pankreas. Ihre häufigste Ursache ist der Alkoholmissbrauch. Die hereditäre Pankreatitis ist eine meist autosomal-dominant vererbte Form der chronischen Pankreatitis, mit einer phänotypischen Penetranz von bis zu 80%. Patienten mit hereditärer Pankreatitis haben ein stark erhöhtes Risiko ein Pankreaskarzinom zu entwickeln. Bei heute noch fehlenden kausalen Optionen ist die Behandlung symptomorientiert und auf die chronischen Schmerzen und die Substitution der exokrinen und endokrinen Pankreasinsuffizienz gerichtet. Komplikationen wie persistierende Schmerzen, Strikturen des D. hepatocholedochus, Pankreaspseudozysten oder -gangsteine, die eine interventionelle/operativ-chirurgische Therapie erfordern können, entwickeln sich in 30–60%.

Abstract

Chronic pancreatitis is defined as a recurrent inflammation of the pancreas that leads to loss of exocrine and endocrine pancreatic function. Its most common cause is alcohol abuse. Hereditary pancreatitis is a form of pancreatitis that mostly has an autosomal dominant mode of inheritance and is characterised by a phenotypic penetrance of up to 80%. Patients with hereditary pancreatitis have a markedly elevated lifetime risk of developing pancreatic cancer. As there is still no causal treatment, therapy focuses on pain control and replacement therapy for endocrine and exocrine pancreatic insufficiency. In 30–60% of patients disease-associated complications such as persistent pain, strictures of the common bile duct or pancreatic duct stones develop, which may require either interventional or surgical treatment.

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  1. Klinik für Innere Medizin A, Universitätsklinikum Greifswald der Ernst-Moritz-Arndt-Universität, Friedrich-Loeffler-Str. 23, 17475, Greifswald, Deutschland

    J. Mayerle &  M.M. Lerch

  2. Abteilung für Allgemeine Chirurgie, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Greifswald der Ernst-Moritz-Arndt-Universität, Greifswald, Deutschland

    C.D. Heidecke

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  1. J. Mayerle
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  2. C.D. Heidecke
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  3. M.M. Lerch
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Correspondence to M.M. Lerch.

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Mayerle, J., Heidecke, C. & Lerch, M. Diagnostik und Therapie der chronischen Pankreatitis. Gastroenterologe 2, 275–290 (2007). https://doi.org/10.1007/s11377-007-0095-4

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