A 49-year-old man presents to the clinic with chronic abdominal pain and progressive weight loss over the past year. He reports intermittent epigastric pain radiating to the back that worsens after meals. His medical history is significant for gastroesophageal reflux disease and alcohol use disorder, and he currently drinks 6–8 beers daily. Medications include omeprazole. Temperature is 36.8°C (98.2°F), blood pressure is 124/76 mm Hg, pulse is 84/min, and respiratory rate is 14/min. Physical examination reveals mild epigastric tenderness. Laboratory studies demonstrate a hemoglobin A1c of 8.2%. Fecal elastase testing is low. Abdominal CT reveals pancreatic calcifications.
Which of the following is the most appropriate treatment for this patient’s malabsorptive symptoms?
The correct answer is:
C: Oral pancreatic enzyme replacement.
This patient has chronic pancreatitis, as evidenced by chronic epigastric pain, pancreatic calcifications, diabetes mellitus, and pancreatic exocrine insufficiency. Pancreatic enzyme replacement improves fat absorption and reduces steatorrhea, weight loss, and nutritional deficiencies. Alcohol cessation is also a critical component of management.
Answer choice A: Broad-spectrum antibiotics, is incorrect.
Antibiotics are not routinely indicated in chronic pancreatitis unless there is evidence of infection.
Answer choice B: Endoscopic retrograde cholangiopancreatography, is incorrect.
ERCP may be used for selected obstructive complications but does not treat exocrine pancreatic insufficiency.
Answer choice D: Total parenteral nutrition, is incorrect.
Most patients with chronic pancreatitis can maintain nutrition through enteral intake and enzyme replacement.
Answer choice E: Ursodeoxycholic acid, is incorrect.
This medication is used for selected cholestatic liver disorders and some gallstone-related conditions.
Key Learning Point
Chronic pancreatitis causes pancreatic exocrine insufficiency, which is treated with pancreatic enzyme replacement therapy.
