Pancreatitis%20-%20chronic Management

Management

Treatment of Complications

Complications of chronic pancreatitis result from endocrine and exocrine insufficiency
Other complications such as a pancreatic pseudocyst, gastroparesis due to chronic pancreatitis, duodenal or biliary obstruction, or a secondary pancreatic cancer should be identified and treated accordingly

Diabetes Mellitus

Diabetes results from destruction of pancreatic acinar cells
- Insulin secretion is not completely lost while glucagon secretion is reduced
Treatment is often directed at controlling urinary glucose losses rather than blood sugar levels
- Avoid tight control of glucose levels as treatment-induced hypoglycemia can be fatal especially in malnourished patients
Insulin is usually required, but some patients may still respond to oral antidiabetic agents
Monitor patients for complications of long-standing diabetes eg nephropathy, neuropathy and retinopathy

Maldigestion

Enzyme supplementation with lipase during and after a meal may reduce steatorrhea
Supplementation with fat-soluble vitamins is beneficial and MCTs can help prevent weight loss
Screen patients for micronutrient and macronutrient deficiencies at least annually
Periodically assess for malnutrition including tests for osteoporosis
Response to treatment may be measured through loss of visible stool fat, improved stool consistency, weight gain and normalization of fat-soluble vitamin levels

Pancreatic Malignancy

Although the prevalence of pancreatic ductal adenocarcinoma is high in patients with chronic pancreatitis, there is currently no definitive benefit in screening patients for pancreatic malignancy

GP symposium 2019: Updates on the Use of Probiotics in Clinical Practice

Dr. Gwee Kok Ann, Dr. Warren Lee, Dr. Mark Tang, Dr. Lim Sanghyun, 24 Apr 2019

Modulation of gut microbiota with probiotics has been studied in a wide range of clinical settings, in the hope of achieving health benefits in the host. Under the auspices of the Asian GI Faculty, four experts discussed the role of probiotics in clinical practice at the recent IMPACT (Improving Medical Practice through Advancement in Clinical Treatment) GP symposium in Singapore sponsored by DCH Auriga.

Long COVID: What we have learned so far

Prof. Ghassan Dbaibo, 27 Apr 2023

The WHO defines long COVID as a condition that occurs 3 months from COVID-19 onset, whose symptoms last ≥2 months and cannot be attributed to an alternative diagnosis. In an interview with MIMS Doctor, Professor Ghassan Dbaibo of the Center for Infectious Diseases, American University of Beirut, Beirut, Lebanon, describes the evolving attitudes towards long COVID among healthcare professionals (HCPs), some unexpected predisposing factors, potential biological mechanisms behind prolonged symptom duration and shares data on vaccination’s protective effects against long COVID.

Updates in the Management of Gastric Cancer

Prof Yasuhiro Kodera, Prof Winnie Yeo, 23 Jul 2019

Globally, gastric cancer is the third leading cause of cancer death.¹ Its primary treatment is gastrectomy with adjuvant chemotherapy or chemoradiotherapy to improve survival. Although neoadjuvant chemotherapy or adjuvant chemoradiation is preferred in Western countries, postoperative adjuvant chemotherapy is still the mainstream therapeutic strategy in Asia.² At a recent symposium in Hong Kong, experts discussed updates in the treatment and management of gastric cancer, with a focus on the use of S-1 (TS-ONE^®; Taiho Pharma Singapore), a combination of tegafur, gimeracil, and oteracil potassium.