Diagnostik og behandling af kronisk pankreatit
Skal patienter med kronisk pankreatit evalueres løbende for udvikling af eksokrin pancreasinsufficiens
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36. Skal patienter med kronisk pankreatit evalueres løbende for udvikling af eksokrin pancreasinsufficiens? Forekomsten af eksokrin og endokrin insufficiens menes at øges ved tiltagende sygdomsvarighed (111-112). Rygning øger risikoen for pancreasforkalkninger, eksokrin pancreasinsufficiens, pancreascancer og knoglefrakturer (113-118). Alkoholforbrug på over 5 genstande dagligt øger risikoen for udvikling af KP, men er ikke påvist at øge risikoen for komplikationer. Både opsamling af fæces fedt i 3 døgn og fækal elastase kan anvendes ved screening for eksokrin pancreasinsufficiens. Fækal elastase har en fordel pga. sin patientvenlighed. 13C mixed triglycerid breath-test kan ligeledes anvendes til screening. Hvis disse metoder er negative og der fortsat er mistanke om begyndende eksokrin pancreasinsufficiens, kan Lundh's måltidstest anvendes. Kliniske rekommandationer
37) Er der øget risiko for pancreascancerudvikling ved kronisk pankreatit? Ca. 5% med KP vil over en 20-års periode udvikle pancreascancer. Erkendes en pancreascancer allerede ca. 1 år efter diagnosticering med KP, skyldes den kroniske pankreatit, at tumor bevirker duktobstruktion (120). Risikoen for udvikling af pancreascancer ved KP er øget med en faktor 16, hvis man samtidig ryger med en faktor 25 (121). Den relative risiko for pancreascancerudvikling er 13% ved KP, ved hereditær pankreatit er den 70% (122). Klinisk rekommandation
38) Skal man screene rutinemæssigt for pancreascancerudvikling ved kronisk pankreatit? Der henvises til de tidligere afsnit. Kliniske rekommandationer
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