Adult Medicine Children's Health Dental Health Emotional Well Being/Psychiatric Dysfunction Health,Prevention, & Care HIV Issues and Topics Nutritional Consultation Sexual Health Issues

Pancreatitis, Chronic

Basic Information

A gland which is located behind the stomach, the pancreas is responsible for secreting digestive enzymes and the hormones insulin and glucagon. When the digestive enzymes are not produced, fat is unable to be digested and absorbed and insulin production is decreased.

Chronic pancreatitis is either recurrent, following attacks of acute pancreatitis (See article on Pancreatitis, Acute) or a persistent inflammation of the pancreas. After an attack of acute pancreatitis, the pancreas is unable to recover to a normal state while it is between attacks. The pancreas eventually destroys healthy glandular tissue in the pancreas and it can no longer supply the hormones or digestive juices that the body requires nor can it properly absorb or digest fat.

Chronic pancreatitis usually develops over 5 to 10 years following a course of heavy alcoholic drinking -- the disease is called chronic because it persists after the causative agent -- most likely alcohol -- has been removed. In fact, patients who present with acute pancreatitis may in fact be covering up a chronic condition that has existed for a number of years with different, often undiagnosed symptoms, but this is their first acute attack.

This is a disease whose markers are:

  • persistent pain (mild to severe)
  • pancreatic endocrine insufficiency
  • pancreatic exocrine insufficiency

The incidence of this disease is increasing. It is currently diagnosed in 1 to 10 per 100,000 in the U.S. population. The cause is related to chronic alcohol consumption in 60 to 80% of cases.

Other causes can include:

  • an obstruction -- biliary tract, tumor, trauma
  • hypercalcemia
  • malnutrition

Who is most at risk?

  • males over females at a 5 to 1 ratio
  • chronic heavy use of alcohol generally over a 6 to 10 year period
  • genetic predisposition (familial history)
  • patients with excess iron in the blood
  • patients with cystic fibrosis

This is a very serious illness because permanent and often progressive (but not always) damage has been done to the pancreas -- food and alcohol often worsen the pain. An attack of acute pancreatitis may be brought on by a period of binge drinking. Diabetes melitis is associated with chronic pancreatitis and hypoglycemia is a risk.

Symptoms

  • mild to severe pain, often made worse after intake of food
  • Pain begins in the upper abdomen but often radiates to the back as with a gallstone attack
  • Painful episodes are generally lengthy, lasting for days or even weeks and rarely resolving before 24 hours.
  • The pain has alternatively been described as aching, gnawing, burning, stabbing.
  • Jaundice occurs in 5 to 10% of patients, usually in those whose chronic pancreatitis is associated with biliary tract disease.
  • foul-smelling stools, bulky and greasy (in 40% of patients)
  • acute pancreatitis (in 40% of patients)
  • weight loss in 80% of patients; marked, rapid weight loss in 40% of patients

Diagnosis/Treatment

Diagnosis includes a familial and medical history taken in a clinical setting and in most cases evaluating the patient's history of chronic alcoholism is key. Tests that are more conclusive for acute pancreatitis are generally given such as serum amylase and lipase measurement but they can be normal in patients with chronic pancreatitis.

Other diagnostic tests may include:

  • ultrasound and radiography to look for pancreatic calcification
  • a contrast-enhanced CT (computed tomography) which has high sensitivity for calcification
  • pancreatic function tests
  • blood glucose measurement and glucose tolerance tests

Treatment goals are to treat pain and malabsorption, to try to identify and then eliminate the underlying cause and attempt, usually by duct drainage, to halt progression of the disease.

Unfortunately prognosis for the disease is variable. It usually takes pain and calcification between 5 and 10 years to occur. In a number of cases regression does result but up to 50% of patients with this disease die after 7 years. The unpredictability of the course of this chronic illness can be the cause of stress and depression and therapy and/or regular visits to a psychiatrist are recommended where the underlying cause can be addressed.

For exocrine insufficiency pancreatic enzyme therapy should be instituted and insulin-therapy is almost always required for endocrine insufficiency.

Management of chronic pain is an important goal. Seeing a pain specialist for options based on the severity of your pain is indicated. Surgery is an option that has often proved successful with patients who have severe pain.

A positive attitude is truly beneficial. Advocating for yourself by making lifestyle changes that can preserve your quality of life include:

  • abstain from alcohol
  • eat regular meals -- work with a nutritionist if possible for maximum benefit

Try different methods of pain management to find what brings you the most relief. Pancreatic supplements containing protease have proven helpful as have analgesics and NSAIDs (nonsteroidal anti-inflammatory drugs). Be sure you ask an experienced pain specialist about what medications are currently available to help control pain. He or she will be able to share experiences about methods that have worked for other patients. Join support groups and build a support network among family, friends and other patients with chronic pancreatitis and follow-up with your health care management team for regular monitoring.

If you have chronic pancreatitis, please see your health care provider promptly. There is much you can do to try to help stop progression of the disease and improve your quality of life.