# Chronic Pancreatitis Outpatient Support & Referral - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ACG Clinical Guideline: Chronic Pancreatitis 2020 for the indication, with the products from Creon 25000 Capsules (pancreatin) SmPC sections 2 and 4.2 (eMC product 1168) - "Each capsule contains pancreatin PhEur 300 mg equivalent to: Lipase ... 25,000 PhEur units" and "Initially one or two capsules during or immediately after each meal" - and Creon 10000 Capsules SmPC section 2 (eMC product 1167) for the smaller strength: "Each capsule contains: Lipase ... 10,000 PhEur units". · ACG Clinical Guideline: Chronic Pancreatitis 2020 · Tramadol 50 mg capsules SmPC section 4.2 (eMC product 7123) · MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain) · Chronic pancreatitis - disease-level clinical article (pancreatitis-chronic-referral-full.txt) - Verified date: 2026-08 ## Verified against - ACG Clinical Guideline: Chronic Pancreatitis 2020 for the indication, with the products from Creon 25000 Capsules (pancreatin) SmPC sections 2 and 4.2 (eMC product 1168) - "Each capsule contains pancreatin PhEur 300 mg equivalent to: Lipase ... 25,000 PhEur units" and "Initially one or two capsules during or immediately after each meal" - and Creon 10000 Capsules SmPC section 2 (eMC product 1167) for the smaller strength: "Each capsule contains: Lipase ... 10,000 PhEur units". - ACG Clinical Guideline: Chronic Pancreatitis 2020 - Tramadol 50 mg capsules SmPC section 4.2 (eMC product 7123) - Chronic Pancreatitis - disease-level clinical article (pancreatitis-chronic-referral-clinical.txt) - MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain) - Chronic pancreatitis - disease-level clinical article (pancreatitis-chronic-referral-full.txt) ## Treatment metadata - Pancreatin — oral.solid - Referral & safety-netting (no drug therapy) - Paracetamol — 500 mg — oral.solid - Tramadol — 50 mg — oral.solid ## Complete treatment card ```text CHRONIC PANCREATITIS OUTPATIENT SUPPORT & REFERRAL Sources: ACG Clinical Guideline: Chronic Pancreatitis 2020 for the indication, with the products from Creon 25000 Capsules (pancreatin) SmPC sections 2 and 4.2 (eMC product 1168) - "Each capsule contains pancreatin PhEur 300 mg equivalent to: Lipase ... 25,000 PhEur units" and "Initially one or two capsules during or immediately after each meal" - and Creon 10000 Capsules SmPC section 2 (eMC product 1167) for the smaller strength: "Each capsule contains: Lipase ... 10,000 PhEur units". · ACG Clinical Guideline: Chronic Pancreatitis 2020 · Tramadol 50 mg capsules SmPC section 4.2 (eMC product 7123) · MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain) · Chronic pancreatitis - disease-level clinical article (pancreatitis-chronic-referral-full.txt) Review status: REVIEWED against ACG Clinical Guideline: Chronic Pancreatitis 2020 for the indication, with the products from Creon 25000 Capsules (pancreatin) SmPC sections 2 and 4.2 (eMC product 1168) - "Each capsule contains pancreatin PhEur 300 mg equivalent to: Lipase ... 25,000 PhEur units" and "Initially one or two capsules during or immediately after each meal" - and Creon 10000 Capsules SmPC section 2 (eMC product 1167) for the smaller strength: "Each capsule contains: Lipase ... 10,000 PhEur units"., ACG Clinical Guideline: Chronic Pancreatitis 2020, Tramadol 50 mg capsules SmPC section 4.2 (eMC product 7123), Chronic Pancreatitis - disease-level clinical article (pancreatitis-chronic-referral-clinical.txt), MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain), Chronic pancreatitis - disease-level clinical article (pancreatitis-chronic-referral- full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - Long-standing abdominal pain with pain-free intervals is typical, though some patients have no symptoms at all [abdominal pain] - Leaning forward can ease the pain - Nausea, vomiting, diarrhea, greasy foul-smelling stools that are hard to flush, and weight loss are common [diarrhoea · nausea · vomiting · weight loss] - During severe pain flares, patients may curl their knees to the chest for relief - Glucose intolerance or pancreatic diabetes can develop as the disease progresses - Exocrine failure - insufficiency, steatorrhoea and weight loss - only shows once more than 90% of the organ is damaged [steatorrhoea · weight loss] - In severe disease as many as 85% of patients have pancreatic insufficiency - Endocrine failure gives pancreatogenic diabetes, which is also called type 3c diabetes SIGNS - what you find (3) - Focal or diffuse abdominal tenderness is a common exam finding [abdominal tenderness] - A palpable mass on exam may indicate a pseudocyst - Signs of malnutrition are frequent in long-standing disease TESTS (7) - Fecal fat excretion above 7 g per day on the 72-hour collection confirms steatorrhea from pancreatic insufficiency - A fecal elastase level above 500 microg per gram of stool is considered normal - Fecal elastase below 100 microg per gram of stool indicates severe exocrine pancreatic insufficiency - Calcifications are the hallmark finding on MRCP or CT, along with pancreatic enlargement and duct changes - MRCP is more sensitive and specific than transabdominal ultrasound or plain x-ray for chronic pancreatitis - The 13C-mixed triglyceride breath test is about 90 percent sensitive but takes up to six hours and isn't widely available - End-stage disease means atrophy and fibrosis, pain syndromes, distorted and strictured ducts, calcification, failure of both the exocrine and the endocrine work, and dysplasia IF NOT THIS - what else fits (6) - Small intestinal bacterial overgrowth can explain symptoms that persist despite enzyme therapy - Celiac disease is on the differential for persistent malabsorptive symptoms - Giardia infection should be considered among the parasitic causes - Chronic mesenteric ischemia is on the differential for these persistent symptoms - Inflammatory bowel disease should be considered in the differential - Bile acid malabsorption can produce similar persistent symptoms Source StatPearls "Chronic Pancreatitis" - disease-level clinical article Status traced to the source above Rx: Main treatment | Analgesia - non-opioid, to be tried before an opioid MAIN TREATMENT - choose one, plus any add-on marked below 1. PANCREATIN [1st line] Adult 25,000-50,000 lipase units with main meals, and 10,000-25,000 units with snacks - long- term under specialist monitoring Peds Paediatric cystic fibrosis / CP enzyme dosing: 1000 lipase units/kg/meal under specialist care Source ACG Clinical Guideline: Chronic Pancreatitis 2020 for the indication, with the products from Creon 25000 Capsules (pancreatin) SmPC sections 2 and 4.2 (eMC product 1168) - "Each capsule contains pancreatin PhEur 300 mg equivalent to: Lipase ... 25,000 PhEur units" and "Initially one or two capsules during or immediately after each meal" - and Creon 10000 Capsules SmPC section 2 (eMC product 1167) for the smaller strength: "Each capsule contains: Lipase ... 10,000 PhEur units". Why Pancreatic enzyme replacement therapy (PERT) is essential for malabsorption and steatorrhea Caution Take capsules WITH or immediately after food, swallow whole (do not chew enteric granules). High doses (>10,000 lipase units/kg/day) are associated with fibrosing colonopathy in cystic fibrosis. Advise strict cessation of alcohol and smoking. Egypt DYSPA-EAST 300 MG 20 CAPS. WESTERN PHARM... 140.00 EGP (7.00/unit) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Chronic Pancreatitis - disease-level clinical article (pancreatitis-chronic-referral- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Symptomatic ductal obstruction (strictures or stones) is an indication for endoscopic therapy, surgical intervention, or ESWL - a different pathway from ongoing medical/enzyme therapy. RED FLAG - Chronic pancreatitis carries an increased risk of developing pancreatic ductal adenocarcinoma, warranting vigilance for new or changing symptoms. 3. TRAMADOL [add-on - not a substitute] Adult 50 mg every 6 hours as needed for chronic severe pain, max 400 mg daily - Short-term / intermittent under specialist oversight Peds CONTRAINDICATED in children under 12 years Source Tramadol 50 mg capsules SmPC section 4.2 (eMC product 7123) Why Tramadol is a weak opioid analgesic added to the pain-management plan for chronic pancreatitis when non-opioid measures are insufficient; it controls pain only, does not treat the underlying pancreatic disease, and needs specialist oversight alongside it. Caution Tramadol is a controlled substance in Egypt, with a high potential for dependence and abuse. There is a risk of respiratory depression, constipation, and lower seizure threshold. Pain management in chronic pancreatitis requires multidisciplinary specialist oversight. Over 75 years, elimination is prolonged - lengthen the interval between doses rather than keeping to six-hourly. Do not exceed 400 mg in 24 hours. Egypt TRAMAL 50MG 20 CAPS. MINA PHARM > ... 18.00 EGP (0.90/unit) TRAMADOL 50 MG 20 CAPS. MEMPHIS 22.00 EGP (1.10/unit) AMADOL 50 MG 20 CAPS. ADWIA 29.00 EGP (1.45/unit) CONTRAMAL 100MG/ML ORAL DROPS 10 ML SIGMA 9.00 EGP -> ? strength differs, ? different route - not oral solid TRAMAL 100MG/ML ORAL DROPS. 10 ML MINA PHARM > GRUNENTHAL-GERMANY 18.00 EGP -> ? strength differs, ? different route - not oral solid ANALGESIA - NON-OPIOID, TO BE TRIED BEFORE AN OPIOID 4. PARACETAMOL [1st line] Adult 1 g 3 or 4 times daily (maximum 4 g daily) Peds 15 mg/kg/dose [child max 500 mg] (MSF: child 1 month and over, 15 mg/kg 3 or 4 times daily (maximum 60 mg/kg daily); child under 1 month, 10 mg/kg 3 or 4 times daily (maximum 40 mg/kg daily).) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain) Why The card's only analgesic was tramadol, an opioid, on a condition whose article says management should prioritise non-opioid medications before considering opioids and names acetaminophen or paracetamol as the first of those first-line options. The card therefore offered the step the article puts second and not the one it puts first. MSF's indication for paracetamol is mild pain and fever; it does not name chronic pancreatitis, and that link comes from the disease article - the caution says so. Caution Do not exceed indicated doses, especially in children and older patients. Paracetamol intoxications are severe (hepatic cytolysis). The MSF indication is mild pain and fever; it does not name chronic pancreatitis, and that link comes from the disease article. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)