Guideline for the diagnosis and treatment of chronic XXXX .

@entity1 @entity32 @entity788 @entity167 @entity1689 @entity458 @entity158 @entity734
BACKGROUND: @entity1689 ( @entity1689 ) is defined as a continuing @entity32 characterised by irreversible morphological changes, often associated with @entity158 and with the loss of exocrine and/or endocrine function that may be clinically relevant. @entity167 is the predominant cause of @entity1689 in the western world and is particularly prevalent in South Africa, especially in the indigent @entity1 . @entity1689 ranks high among intractable diseases of the gastrointestinal tract. The tendency for @entity734 in the @entity167 -induced group poses major @entity458 . OBJECTIVE: @entity1689 is a disease with significant clinical and pathological heterogeneity. Level 1 evidence to support definitive guidelines for diagnosis, medical management and interventional therapy is lacking. Despite this paucity of robust scientific evidence, it is important to provide some assistance based on the best available evidence as to the current standard of care for @entity1689 in the South African context; this will aid all involved in the management of the disease, and includes clinicians, health care managers and funders. SCOPE: The guidelines were developed as recommendations addressing the diagnosis, medical management and interventions, both endoscopic and surgical, for the management of a very complex and @entity788 . The recommendations are particularly relevant in the South African context where the predominant patho-aetiological agents are @entity167 -associated with smoking. RECOMMENDATIONS: The guidelines provide clear recommendations regarding the diagnostic modalities available, both imaging (which includes MRI and endoscopic ultrasound (EUS)) and pancreatic function tests. The section on medical management makes recommendations on the use of analgesics, enzyme replacement and other therapeutic options in the non-interventional management of the majority of @entity1 with @entity1689 . The section on interventional procedures identifies the indications and options available for the interventional management of both uncomplicated and complicated @entity1689 . The role of endoscopic and surgical modalities is defined, but it is in this context especially that the best available evidence, combined with the experience of the group, influenced the recommendations put forward. Owing to the lack of evidence and the complexity of the disease, it is recommended that, where possible, @entity1689 is managed in the context of a multidisciplinary team. VALIDATION: The guidelines are based on best practice principles determined by the available evidence and the opinions of the group, which comprised 7 medical and surgical gastroenterologists with significant experience in dealing with @entity1 with chronic @entity788 in the South African context. The group convened between May 2009 and August 2010 under the auspices of the Hepato-Pancreatico-Biliary Association of South Africa (HPBASA) and the South African Gastroenterology Society (SAGES), and the guidelines are the result of broad consensus within this group. The draft was presented to other experts in this field of endeavour to ensure broader participation and consensus. PLANS FOR GUIDELINE REVISION: HPBASA and SAGES will publish a revised modification of the recommendations when new levels 1 and 2 evidence data are published.
