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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 results from prolonged injury, toxic exposure, autoimmune disease, or obstruction of the pancreas.

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:

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 may be mild, but progressive. Chronic pancreatitis may cause:

  • Abdominal pain that: may get worse when eating or drinking, spreading to the back, or become constant and disabling
    • Spreads to the back
    • Gets worse when eating or drinking
    • Becomes constant or disabling
  • Nausea and vomiting
  • Weight loss
  • Diarrhea—with presence of excess fat or nitrogen-based substances in the stool
Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. The diagnosis of chronic pancreatitis is difficult. Symptoms are not specific early on in the course of the disease.

Tests may include

  • Blood tests—to look for elevated levels the digestive enzymes or other conditions
  • Stool tests

Imaging tests can be used to evaluate the pancreas nearby structures. Imaging tests include:

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

Your doctor will advise you 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.

Your doctor may also suggest that you 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.
  • ECRP—To open any collapsed ducts or drain cysts.
  • Cholecystectomy—To remove the gallbladder.
Prevention

Aside from avoiding too much alcohol, there are no current guidelines to prevent chronic pancreatitis. If you have recurrent attacks or are at high risk for developing chronic pancreatitis, you can make other lifestyle changes that may reduce your risk.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

National Pancreas Foundation
http://www.pancreasfoundation.org

CANADIAN RESOURCES:

Canadian Association of Gastroenterology
http://www.cag-acg.org

Health Canada
http://www.hc-sc.gc.ca

References:

Chronic pancreatitis. DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated April 22, 2013. Accessed December 4, 2013.

Chronic pancreatitis. Tulane University School of Medicine website. Available at: http://tulane.edu/som/pancreas-biliary/diseases/chronic-pancreatitis.cfm. Accessed December 4, 2013.

Grant JP. Nutritional support in acute and chronic pancreatitis. Surg Clin North Am. 2011;91(4):805-820, viii.

Pancreatitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis. Updated August 16, 2012. Accessed December 4, 2013.

Singh VV, Toskes PP. Medical therapy for chronic pancreatitis pain. Curr Gastroenterol Rep. 2003; 5:110.



Last reviewed December 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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