What are the indications for referral to a specialist in cases of chronic pancreatitis?

Referral to a specialist in cases of chronic pancreatitis should be considered if there are:

• Uncontrolled or recurrent symptoms, including pain or other complications, that require further assessment and management, such as imaging or intervention, depending on clinical judgement ¹.
• Persistent or worsening pain, or if symptoms change or new symptoms develop, warranting further investigation with imaging like CT or MRI ¹.
• Evidence of complications such as pancreatic exocrine insufficiency with malabsorption or malnutrition, especially if symptoms persist despite pancreatic enzyme replacement therapy ¹.
• Ongoing symptoms of pancreatic exocrine insufficiency despite treatment, requiring specialist pancreatic function testing ¹.
• Suspected pancreatic cancer, which requires urgent referral via a 2-week wait pathway ¹.
• Presence of complications such as pseudocysts, pancreatic duct obstruction, or pseudocyst-related pressure effects, which may need invasive management ¹.
• Persistent or worsening pain that may benefit from specialist pain management, including pain clinic referral ¹.
• Pancreatic ascites or pleural effusion, which should be managed in a specialist pancreatic centre ¹.
• Type 3c diabetes, which should be assessed every 6 months and may require specialist endocrine management ¹.