A 54-Year-Old Man With Abdominal Pain Attributed to Chronic Pancreatitis

A 54-year-old man presents for evaluation of a 1-year history of epigastric pain radiating to the back. The pain is constant in character and is present on most days. On some days the pain is debilitating and rated as 10 out of 10. There are associated daily nausea and occasional vomiting. The pain is most bothersome during the day but will awaken the patient from sleep. The patient had consumed 5–6 beers/day for 30 years, but since the pain began, he reduced his intake to 1–2 drinks daily. Evaluation by his primary care physician includes a normal complete blood count, electrolytes, liver chemistries, and amylase and lipase. Upper gastrointestinal endoscopy shows no signs of peptic ulcer disease. Computed tomography (CT) of the abdomen shows scattered pancreatic parenchymal calcifications and dilation of the main pancreatic duct to 7 mm in maximum diameter. No mass, peripancreatic fluid collection, or biliary dilation is present. The patient has been treated by his primary care provider with enteric-coated pancreatic enzymes with no improvement of his pain.