Chronic pancreatitis

Chronic pancreatitis is inflammation of the pancreas that causes permanent damage and does not abate. The pancreas is a small gland that lies behind the liver and under the stomach. It produces insulin and various digestive enzymes. Pancreatitis is frequently caused by excessive alcohol use, although sometimes the cause is unknown or idiopathic. The primary symptoms are abdominal pain (sometimes severe) and digestive problems which can eventually lead to malnutrition. Long-term medical and (occasionally) surgical management are required. This condition cannot be cured.

Definition & Facts

The pancreas normally produces enzymes that promote digestion of food in the intestines. Special cells in the pancreas called the islets of Langerhans produce hormones like insulin and glucagon, which regulate blood sugar.

Pancreatitis is inflammation of the pancreas. It may be acute or chronic. In the acute form, pain and inflammation subside after the initial attack. If they reoccur, the condition is said to be chronic. The chronic form of pancreatitis damages and causes physical changes to the gland itself, which may become hard and/or riddled with cysts. This damage affects the function of the pancreas.

Approximately five to 12 of each 100,000 people in industrialized countries will develop chronic pancreatitis each year. In the United States, chronic pancreatitis results in more than 56,000 hospitalizations each year, according to the Cleveland Clinic. The condition usually appears between the ages of 30 and 40. Chronic pancreatitis is more common among men than women.

Symptoms & Complaints

Eating triggers pancreatic activity, and the pain typically becomes worse after eating. Pain usually follows one of two patterns: occasional bouts of pain followed by days or weeks without pain, or severe unrelenting pain. The latter usually indicates a greater likelihood of disability and often requires strong injectable narcotics.

In addition to pain, pancreatitis may be accompanied by nausea and vomiting. Eventually, the disease can cause malnutrition and unexplained weight loss, as the disease affects appetite, and damage to the pancreas results in decreased secretion of digestive enzymes.

Causes

Alcohol abuse is the most common cause of chronic pancreatitis. It is also more likely than other causes to result in more severe pain, more damage to the pancreas and a more rapid progression of the disease. The combination of alcoholism, smoking, and a high fat diet may also increase the risk of developing pancreatitis.

However, other forms of chronic pancreatitis have differing causes. In tropical chronic pancreatitis, the condition may begin in childhood and is thought to be due to nutritional deficiencies. Although uncommon, chronic pancreatitis can result from an autoimmune disease like lupus or from gallstones.

A high level of calcium in the blood has been known to trigger acute pancreatitis, which can progress to the chronic form, and kidney failure is also associated with an increased risk of chronic pancreatitis. In some cases, the cause cannot be determined.

Diagnosis & Tests

Chronic pancreatitis is usually diagnosed through assessment of the patient's symptoms and a combination of several imaging studies or lab tests. An X-ray called the KUB (kidneys, ureters and bladder X-ray); computed tomography (CT) scans; and magnetic resonance imaging (MRI) scans are all imaging studies that allow the pancreas to be visualized. Each can show different areas or specific information, and so all may be performed during the diagnostic process. A pancreatic protocol CT scan is another, more specific diagnostic tool.

Lab tests include measurement of digestive enzymes, especially the serum amylase, an enzyme that helps digest carbohydrates and is typically slightly elevated in cases of chronic pancreatitis. A minimally invasive test called an ERCP-endoscopic retrograde cholangiopancreatography-can allow the physician to view the pancreas and other structures.

Treatment & Therapy

Treatment of chronic pancreatitis has three major components: pain management, improving digestive function, and management of complications.

The first treatment step is for the patient to abstain from alcohol. Alcohol makes pancreatitis worse and increases the likelihood of painful attacks; it also has numerous other negative health effects. Smoking is also known to make chronic pancreatitis worse, so smoking cessation is strongly advised.

Over-the-counter pain relievers like acetaminophen are usually the first step for pain management, but if pain is severe and unrelenting, opioid narcotics may be necessary. Pancreatic enzymes taken by mouth can help relieve pain by decreasing stimulation of the pancreas. These enzymes may also help reduce the likelihood of digestive problems and malnutrition. Antioxidants such as vitamin C and vitamin E have been used in some patients, but the research to support this technique is limited.

Occasionally, surgery may be helpful for pain that is otherwise unresponsive to treatment and in some cases, a nerve block may relieve pain. If pain is the result of stones in the pancreatic duct, they may need to be removed. Cysts in the pancreas are a common complication of chronic pancreatitis, and sometimes stones obstruct the ducts in the pancreas or liver. These conditions are usually treated surgically.

Since pancreatitis is a chronic condition that must be managed rather than cured, patients often try complementary lifestyle therapies. Among these are yoga, massage therapy, therapeutic touch, meditation, and acupuncture. Regular exercise can also help to regulate hormonal balance.

Prevention & Prophylaxis

Other than these two basic strategies, there really is no way to prevent pancreatitis, particularly if the condition stems from genetic factors.