Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 543

Pain is relatively less common in the elderly with chronic pancreatitis, but when it occurs, it impairs the quality of life. Opiate drugs should be avoided because of the risks of narcotic medications in the elderly, including narcotic dependence. Non‐steroidal anti‐inflammatory drugs (NSAIDs), tricyclic antidepressants, and neuromodulators (e.g. gabapentin) are often first‐line therapies.

If drug therapy fails to control pain, other options, such as deafferentation techniques (e.g. celiac axis block), have been tried with variable success. If imaging shows clinically significant pancreatic duct strictures or large obstructing pancreatic duct stones, ERCP can be an option before surgical techniques are considered. In general, surgery for chronic pancreatitis should be rare, and the best outcomes are generally in the subgroup of patients with a distinct pancreatic ductal stricture causing a ductal obstruction that can be relieved surgically. Surgical pancreatic resections or total pancreatectomy with islet autotransplantation (TPIAT) have gained increasing success in the younger population for the treatment of CP; however, they have not been well studied in the older population.

Attempts to control steatorrhea by orally administered pancreatic enzymes are worthwhile, and the dose should be titrated to achieve a normal bowel movement frequency. Malabsorption of fat‐soluble vitamins occurs and should be treated with appropriate supplements.