Chronic pancreatitis

Definition

Chronic pancreatitis is inflammation of the pancreas that does not heal or improve, gets worse over time, and leads to permanent damage.

Alternative Names

Causes, incidence, and risk factors

The pancreas is an organ located behind the stomach that produces chemicals (called enzymes) needed to digest food. It also produces the hormones insulin and glucagon.

When inflammation and scarring of the pancreas occur, the organ is no longer able to make the right amount of these enzymes. As a result, your body may be unable to digest fat and other important parts of food.

Damage to the portions of the pancreas that make insulin may lead to diabetes.

The condition is most often caused by alcohol abuse over many years. Repeat episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be a factor in some cases. Sometimes the cause is not known.

Other conditions that have been linked to chronic pancreatitis:

• Autoimmune problems (when the immune system attacks the body)
• Blockage of the pancreatic duct or the common bile duct, the tubes that drain enzymes from the pancreas
• Complications of cystic fibrosis
• High levels of a fat called triglycerides in the blood (hypertriglyceridemia)
• Hyperparathyroidism
• Use of certain medicationss (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine)

Chronic pancreatitis occurs more often in men than in women. The condition often develops in people ages 30 - 40.

Symptoms

• Abdominal pain
  • Greatest in the upper abdomen
  • May last from hours to days
  • Eventually may be continuous
  • May get worse from eating or drinking
  • May get worse from drinking alcohol
  • May also be felt in the back
• Digestive problems
  • Chronic weight loss, even when eating habits and amounts are normal
  • Diarrhea, nausea, and vomiting
  • Fatty or oily stools
  • Pale or clay-colored stools

The symptoms may become more frequent as the condition gets worse. The symptoms may mimic pancreatic cancer. Sitting up and leaning forward may sometimes relieve the abdominal pain of pancreatitis.

Signs and tests

Tests for pancreatitis include:

• Fecal fat test
• Serum amylase
• Serum IgG4 (for diagnosing autoimmune pancreatitis)
• Serum lipase
• Serum trypsinogen

Inflammation or calcium deposits of the pancreas, or changes to the ducts of the pancreas may be seen on:

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

An exploratory laparotomy may be done to confirm the diagnosis, but this is usually done for acute pancreatitis.

Treatment

People with severe pain or who are losing weight may need to stay in the hospital for:

• Pain medicines
• Fluids given through a vein (IV)
• Stopping food or fluid by mouth to limit the activity of the pancreas, and then slowly starting an oral diet
• Inserting a tube through the nose or mouth to remove the contents of the stomach (nasogastric suctioning) may sometimes be done. The tube may stay in for 1 - 2 days, or sometimes for 1 - 2 weeks.

Eating the right diet is important for people with chronic pancreatitis. A nutritionist can help you create the best diet to maintain a healthy weight and receive the correct vitamins and minerals. All patients should be:

• Drinking plenty of liquids
• Eating a low-fat diet
• Eating small, frequent meals (this helps reduce digestive symptoms)
• Getting enough vitamins and calcium in the diet, or as extra supplements
• Limiting caffeine

The doctor may prescribe pancreatic enzymes, which you must take with every meal. The enzymes will help you digest food better and gain weight.

Avoid smoking and drinking alcoholic beverages, even if your pancreatitis is mild.

Other treatments may involve:

• Pain medicines or a surgical nerve block to relieve pain
• Taking insulin to control blood sugar (glucose) levels

Surgery may be recommended if a blockage is found. In severe cases, part or all of the pancreas may be removed.

Support Groups

Expectations (prognosis)

This is a serious disease that may lead to disability and death. You can reduce the risk by avoiding alcohol.

Complications

• Ascites
• Blockage (obstruction) of the small intestine or bile ducts
• Blood clot in the vein of the spleen
• Fluid collections in the pancreas (pancreatic pseudocysts) that may become infected
• Poor function of the pancreas
  • Diabetes
  • Fat or other nutrient malabsorption
  • Vitamin malabsorption (most often the fat-soluble vitamins, A, D, E, or K)

Calling your health care provider

Call for an appointment with your health care provider if:

• You develop symptoms of pancreatitis
• You have pancreatitis and your symptoms get worse or do not improve with treatment

Prevention

Determining the cause of acute pancreatitis and treating it quickly may help prevent chronic pancreatitis. Not drinking a lot of alcohol reduces the risk of developing this condition.

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References

Nair RJ, Lawler L, Miller MR. Chronic pancreatitis. Am Fam Physician. 2007;76:1679-1688.

Owyang C. Chronic pancreatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 147.