Chronic Pancreatitis

Definition

The pancreas is a long, flat, pear-shaped organ located behind the stomach. It makes digestive enzymes and hormones, including insulin. Chronic pancreatitis is a progressive inflammation of the pancreas marked by frequent acute attacks and risk of permanent organ damage.

Pancreatitis

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Causes

Chronic pancreatitis may result from injury, chronic infection, drug or toxic exposure, autoimmune disease, or blockage of the pancreas. In some cases it is genetic and sometimes has no known cause.

Risk Factors

Chronic pancreatitis is more common in men. Other factors that may increase your risk of chronic pancreatitis include:

Personal health history, such as:

• Alcohol use disorder
• Smoking
• Obesity
• Recurrent attacks of acute pancreatitis
• Chronic kidney disease
• Gallstones
• Alpha 1 anti-trypsin deficiency
• Congenital conditions, such as pancreas divisum
• Ischemia—insufficient blood supply to the pancreas
• Hyperlipidemia —elevated blood fat levels
• Hypertriglyceridemia—elevated blood triglyceride levels
• Hypercalcemia —elevated blood calcium levels
• Cystic fibrosis
• Autoimmune disease
• Family history of:
  • Chronic pancreatitis
  • Hyperparathyroidism associated with chronic pancreatitis
  • Hypercalcemia

Conditions that obstruct the passageway from the pancreas to the small intestine include:

• Trauma
• Tumors
• Pseudocysts—build up of fluids and debris

Chronic pancreatitis is a risk factor for developing pancreatic cancer .

Symptoms

Symptoms are not specific early on in the course of the disease. They may be mild, but progressive. Chronic pancreatitis may cause:

• Abdominal pain that may get worse when eating or drinking, spreads to the back, or becomes constant and disabling
• Nausea and vomiting
• Weight loss
• Diarrhea
• White, fatty, or oily stools
• Symptoms of diabetes
• Yellowish color of the skin or whites of the eyes— jaundice

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. The diagnosis of chronic pancreatitis is difficult.

Test may include:

• Blood tests
• Stool tests

Certain enzymes are much higher in the blood with chronic pancreatitis. The stool may have more fat.

Images may be taken of your bodily structures. This can be done with:

• Abdominal ultrasound
• Abdominal CT scan
• Magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic retrograde cholangiopancreatography (ERCP)

Treatment

The goals of treatment for chronic pancreatitis are to relieve pain, and manage nutritional and metabolic problems.

Treatment may be started in a hospital until you are stabilized. Stabilization can be done with:

• IV fluids
• Nasogastric tube—A long, thin tube is threaded through your nose and into your stomach for feeding

Medications

Your doctor may recommend:

• Prescription pain relievers
• Pancreatic enzymes
• Vitamin supplements
• Medications to control diabetes if it develops

Lifestyle Changes

You will be advised to stop drinking alcohol. This may require counseling or a rehabilitation program. Stopping your alcohol intake is the most important intervention in your treatment.

If you smoke, talk to your doctor about how you can successfully quit .

You may be advised to restrict the amount of fat in your diet. Pancreatic damage interferes with the body's ability to process fats. A registered dietitian can work with you and create a healthy meal plan.

Surgery

Surgery may be needed in severe cases:

• Necrosectomy—Removal of dying or dead (necrotic) pancreatic tissue. Pancreatic necrosis is more serious if an infection is present. This procedure can also be done with endoscopy.
• ERCP—To open any collapsed ducts or drain cysts.
• Cholecystectomy —To remove the gallbladder.

Prevention

To help reduce your chances of chronic pancreatitis, avoid or stop using tobacco and alcohol.