Chronic Pancreatitis

What is chronic pancreatitis?

Chronic pancreatitis is an ongoing or repeated inflammation of the pancreas.

The pancreas is an organ located behind the stomach. It produces digestive enzymes and insulin. The digestive enzymes flow into the small intestine to help break down food. Insulin is released into the blood to control the level of sugar (glucose) in the blood.

Pancreatitis can be acute or chronic. Acute pancreatitis occurs as one sudden episode. After acute pancreatitis the pancreas usually returns to its normal condition. Chronic pancreatitis means ongoing or repeated bouts of pancreatitis in which there is permanent damage to the pancreas. The damaged pancreas gradually becomes unable to produce normal digestive enzymes and insulin.

How does it occur?

Chronic pancreatitis may result from:

• drinking too much alcohol (the most common cause)
• gallstones, which block the normal flow of pancreatic secretions into the intestines
• too much fat in the blood.

In rare cases pancreatitis is inherited.

What are the symptoms?

The main symptoms of chronic pancreatitis are:

• severe pain in the stomach area that extends to the back
• vomiting.

The pain is usually a constant, dull pain that gets worse when you eat food or drink alcohol. The pain may lessen when you sit up and lean forward. As the disease gets worse, attacks of pain last longer and happen more often. Attacks may last a few hours or as long as several weeks.

Weight loss is another common symptom.

As the pancreas becomes damaged, it produces fewer digestive enzymes for the intestines. As a result, food is poorly absorbed. Bowel movements become frequent and foul smelling.

If the pancreas is unable to produce the hormone insulin, diabetes may develop, causing these symptoms:

• increased thirst
• increased appetite
• increased urination
• fatigue
• weight loss.

How is it diagnosed?

Your health care provider will ask about your medical history, particularly about how much alcohol you drink and whether you have had gallstones. Your provider will ask about your symptoms and examine you.

You may have the following tests:

• blood tests, especially to check your blood sugar, amylase, and lipase levels (amylase and lipase are enzymes made by the pancreas)
• urine tests
• x-rays of your abdomen and chest
• ultrasound exam of the pancreas and gallbladder
• CT scan of the pancreas
• ERCP, a way of looking at your pancreas through a slim flexible tube (endoscope) that is passed through your mouth and stomach to where your pancreas and intestines are connected
• biopsy, an exam of tissue removed from the pancreas, usually through the endoscope.

How is it treated?

The goals of treatment are:

• to control the pain
• to prevent further damage to the pancreas
• to prevent further attacks of pancreatitis.

You will need:

• pain medicine
• a diet of foods that are easy to digest
• lots of fluids
• medicine for nausea and vomiting.

If your pancreatitis is severe, you may need to not eat or drink for a few days. In this case you will stay in the hospital so you can be given fluids through your veins (IV).

You may need insulin to control your blood sugar if the pancreas is not producing enough insulin. You may also need enzyme pills to replace the digestive enzymes that the pancreas may not be able to make or get into the intestine because of swelling.

In some cases your health care provider may recommend surgery to help relieve pain or to help the pancreas work better.

If you have alcoholic pancreatitis, no treatment will prevent pancreatitis or relieve your pain if you continue to drink alcohol.

How long will the effects last?

As with any chronic disease, the effects may last for months or years. If you avoid alcohol completely, follow your diet, and take the medicine prescribed by your health care provider, your chances for improvement are good.

If your pancreatitis is caused by gallbladder disease or high blood fats, treating these problems will make future attacks of pancreatitis less likely.

How can I take care of myself?

The most important thing to do is stop drinking all kinds of alcohol. Also follow the diet and take the medicines your health care provider prescribes to help your pancreas heal.

How can I help prevent chronic pancreatitis?

If you drink heavily, get help for stopping. Talk to your health care provider about referral to an alcohol treatment center or a group like Alcoholics Anonymous.