Chronic Pancreatitis

Publication Date: February 1, 2020
Last Updated: March 14, 2022


Diagnosis of CP

1. We recommend CTor MRI for the first-line diagnosis of CP. Either test should be the first choice for the diagnosis of CP. Endoscopic ultrasonography (EUS), because of its invasiveness and lack of specificity, should be used only if the diagnosis is in question after cross-sectional imaging is performed. (Strong  “We recommend”, Low)
2. We suggest performing secretin-enhanced magnetic resonance cholangiopancreatography (s-MRCP) when the diagnosis of CP following cross-sectional imaging or EUS is not confirmed and the clinical suspicion remains high. (Conditional (weak)  “We suggest”, Low)
3. We suggest histological examination as the gold standard to diagnose CP in high-risk patients when the clinical and functional evidence of CP is strong, but imaging modalities are inconclusive. (Conditional (weak)  “We suggest”, Very low)

Etiology of CP

4. We recommend genetic testing in patients with clinical evidence of a pancreatitis-associated disorder or possible CP in which the etiology is unclear, especially in younger patients. (Strong  “We recommend”, Low)

Natural history and clinical symptoms of CP

5. We recommend alcohol cessation in patients with CP. (Strong  “We recommend”, Very low)
6. We recommend smoking cessation in patients with CP. (Strong  “We recommend”, Very low)

Management of pain in CP

7. We recommend surgical intervention over endoscopic therapy in patients with obstructive CP for the long-term relief of pain if first-line endoscopic approaches to pancreatic drainage have been exhausted or unsuccessful. (Strong  “We recommend”, Moderate)
8. We suggest considering the use of antioxidant therapy for CP with pain, although the benefit of pain reduction is likely limited. (Conditional (weak)  “We suggest”, Moderate)
9. We do not suggest the use of pancreatic enzyme supplements to improve pain in CP. (Conditional (weak)  “We suggest”, Low)
10. We suggest considering celiac plexus block for treatment of pain in CP. (Conditional (weak)  “We suggest”, Very low)

Management of exocrine pancreatic insufficiency in CP

11. We suggest pancreatic enzyme replacement therapy (PERT) in patients with CP and exocrine pancreatic insufficiency to improve the complications of malnutrition. (Conditional (weak)  “We suggest”, Low)

Recommendation Grading




Chronic Pancreatitis

Authoring Organization

Publication Month/Year

February 1, 2020

Last Updated Month/Year

July 5, 2023

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Document Objectives

This guideline will provide an evidence-based practical approach to the diagnosis and management of CP for the general gastroenterologist.

Target Patient Population

Patients with chronic pancreatitis

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D010195 - Pancreatitis, D007165 - Immunosuppression, D007166 - Immunosuppressive Agents, D001327 - Autoimmune Diseases, D050500 - Pancreatitis, Chronic


autoimmune, chronic inflammatory disease (CID), pancreatitis, chronic pancreatitis, inflammatory

Source Citation

Gardner, Timothy B. MD, MS, FACG; Adler, Douglas G. MD, FACG; Forsmark, Chris E. MD, FACG; Sauer, Bryan G. MD, MSc (Clin Res), FACG (GRADE Methodologist); Taylor, Jason R. MD; Whitcomb, David C. MD, PhD, FACG. ACG Clinical Guideline, The American Journal of Gastroenterology: March 2020 - Volume 115 - Issue 3 - p 322-339 doi: 10.14309/ajg.0000000000000535