What is cryptopancreatitis (inflammation of the pancreas)?

From the Guidelines

Cryptopancreatitis should be managed with a multidisciplinary approach, focusing on supportive care, including intravenous fluids, pain management, and bowel rest, with the goal of reducing morbidity, mortality, and improving quality of life. The diagnosis of cryptopancreatitis can be challenging due to the absence of elevated pancreatic enzymes in the blood, and therefore, it relies on clinical symptoms and imaging studies such as CT scan or MRI 1.

Key Considerations

• Patients with cryptopancreatitis may present with abdominal pain consistent with pancreatitis, but without biochemical evidence of pancreatitis, making diagnosis more complex 1.
• The management of cryptopancreatitis involves supportive care, including intravenous fluids, pain management with medications like morphine or hydromorphone, and bowel rest, similar to other forms of pancreatitis 1.
• For mild cases, patients can resume oral intake when pain improves and may take acetaminophen 650mg every 6 hours or ibuprofen 400-600mg every 6-8 hours for pain, with the goal of minimizing morbidity and improving quality of life.
• Severe cases require hospital admission with IV hydration using lactated Ringer's solution at 5-10 mL/kg/hr initially, NPO (nothing by mouth) status, and possibly nutritional support if prolonged, to reduce mortality and morbidity 1.

Important Recommendations

• Early diagnosis and intervention are crucial in reducing the risk of complications and improving outcomes in patients with cryptopancreatitis 1.
• A low-fat diet, complete avoidance of alcohol, cessation of smoking, and regular follow-up are recommended after recovery to monitor for complications like pseudocysts or progression to chronic pancreatitis, and to improve quality of life.
• The use of the Revised Atlanta Classification 2012 (RAC) or the Determinant-Based Classification of Acute Pancreatitis Severity (DBC) can help in assessing the severity of pancreatitis and guiding management, although the RAC is considered a broader overview and provides a clear definition of diagnosing acute pancreatitis 1.

From the Research

Definition and Diagnosis of Pancreatitis

• Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis, and scarring, often leading to chronic pain 2.
• The diagnosis of chronic pancreatitis remains challenging in early stages of the disease, and diagnostic criteria are classified as definitive, probable, or insufficient evidence 3.
• Acute pancreatitis is a common indication for hospital admission, and the diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 × upper limit of normal, and/or cross-sectional imaging findings 4.

Causes and Risk Factors of Pancreatitis

• The etiology of chronic pancreatitis is multifactorial, although alcoholism is the most significant risk factor in adults 2.
• Chronic pancreatitis is most commonly caused by toxins such as alcohol or tobacco use, genetic polymorphisms, and recurrent attacks of acute pancreatitis 5.
• Gallstones and ethanol predominate as causes of acute pancreatitis, while hypertriglyceridaemia and drugs are notable among many causes 4.

Treatment and Management of Pancreatitis

• Recommended lifestyle modifications for chronic pancreatitis include cessation of alcohol and tobacco use and eating small, frequent, low-fat meals 2.
• Therapeutic endoscopy is indicated to treat symptomatic strictures, stones, and pseudocysts in chronic pancreatitis 2.
• Initial priorities for acute pancreatitis treatment are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy 4.

Complications and Prognosis of Pancreatitis

• The risk of pancreatic cancer is increased in patients with chronic pancreatitis, especially hereditary pancreatitis 2.
• Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality 4.
• Patients with local complications of acute pancreatitis should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy 4.