| Chronic pancreatitis is diagnosed more frequently, with a prevalence of 150/100.000 in recent European studies. The main challenges in chronic pancreatitis are early diagnosis and management of complications. New magnetic resonance imaging techniques are promising to non-invasively explore the progression of fibrosis before the disease develops to end-stage with the main complications of pain, exo- and endocrine insufficiency. New studies have challenged the effect of invasive (endoscopy and surgery) techniques to treat pain in patients with "large duct disease". As such, a randomised controlled study from India (the SCHOKE trial) only showed a marginally better effect of ESWL and ERCP as compared to sham (treatment "as usual"). Prediction of responders to treatment is, therefore, an unmet need in future trials. The International Pancreatic Pain Consortium has established two trials where the pain system is explored with experimental, clinical and laboratory investigations to identify different subtypes responding to medical and invasive treatments. Another obstacle is the assessment of pain, where a new comprehensive questionnaire (COMPAT) has been developed to give more insight into the complexity of pain and compare studies in the future. In exocrine pancreatic insufficiency, new European guidelines will be published in 2024, where methods and treatments for patients in general are outlined, but also specific cases are extensively described. The challenges with diagnosis will also be presented. Post-pancreatic diabetes is a complication that is frequently overlooked. It has features of hormone deficiency but also insulin resistance etc. Recent data have shown that many patients do not receive the recommended metformin and are maltreated with medications that may potentially be harmful as clinicians believe they have type 1 or 2 diabetes. Epidemiological data have suggested that they have more cases of severe hypoglycemia, and recent studies are exploring the so-called brittle diabetes that needs more attention to optimise treatment. |
