Background & Aims. Chronic pancreatitis (CP) is often associated with abdominal pain, which impairs quality of life. The aim of this prospective study was to clarify whether the use of a low-fat elemental diet (ED) is beneficial for managing pain in patients with CP. Methods. Seventeen CP patients with pain despite fat-restricted dietary and conventional medical treatments were enrolled in this prospective study. These patients received low-fat ED therapy in addition to restricting fat intake for 8 weeks. The change of pain severity was examined by interviewing the patient and status of analgesic use. Results. Mean serum levels of amylase and lipase at 8 weeks after the beginning of low-fat ED therapy decreased compared to those before the therapy. At 8 weeks, pain alleviation after low-fat ED therapy was reported in 15 out of 17 patients (88%). Of these 15 patients, 10 patients reported complete pain disappearance. One of 3 patients with severe or moderate pain requiring analgesic was relieved of analgesic use after low-fat ED therapy. Conclusion. Low-fat ED therapy is useful as means of pain control in CP. The therapy is recommended in outpatients with CP who present with pain despite conventional dietary and medical treatments. 1. Introduction Chronic pancreatitis (CP) is characterized histologically by the destruction of acinar cells and presence of irregular fibrosis within the pancreas. Most patients with CP have abdominal pain, maldigestion, and diabetes mellitus [1, 2]. The most frequent and serious clinical symptom is abdominal pain, which occurs in at least 75% of patients suffering from CP [3]. The recurrent or protracted abdominal pain in CP is often difficult to manage and decreases patients’ quality of life. Pain management in CP includes dietary treatment (e.g., fat restriction and cessation of alcohol and tobacco use), medical treatment (e.g., analgesics, high-dose pancreatic enzymes, and acid suppression agents), endoscopic treatment (e.g., sphincterotomy, lithotripsy, and pancreatic duct stenting), and surgery. American Gastroenterological Association guidelines recommend a low-fat diet as the initial management for the pain in CP [4]. It is well known that an elemental diet (ED) has a protective effect in patients suffering from Crohn’s disease [5]. ED has the following features: (1) the digestion of protein by pancreatic enzymes is not required because nitrogen is derived from amino acids alone; (2) ED contains minimal fat. A recent paper by Ito et al. showed 2 patients in whom the oral administration of a low-fat ED (Elental;
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