Chronic Pancreatitis

Written by Helen Colledge and Jennifer Nelson | Published on July 25, 2012
Medically Reviewed by George Krucik, MD

Overview

Chronic pancreatitis affects the organ known as the pancreas, which is located below your stomach. The pancreas produces enzymes, which help to digest your food, and hormones such as insulin, which regulates the level of sugar in your bloodstream. If you have pancreatitis, this means that something has caused your pancreas to become inflamed. A sudden attack that only lasts for a few days is considered acute, but if the condition lasts over a longer period, (even up to several years) this is described as chronic pancreatitis.

Over time, the inflammation can cause scarring and damage. Calcium stones may also develop in your pancreas; these can block the outlet, or pancreatic duct, that carries digestive enzymes and juices into your gut. Levels of pancreatic enzymes and hormones may fall, leading to problems with your digestion and blood sugar regulation. You may develop malnutrition and have excessive amounts of fat in your stools. If you are unable to maintain your blood sugar levels within normal limits, you may develop diabetes.

What Causes Chronic Pancreatitis?

The main cause of chronic pancreatitis is drinking alcohol excessively. Other causes include:

  • autoimmune diseases, in which the body mistakenly attacks itself like rheumatoid arthritis
  • having a narrow pancreatic duct
  • a blockage of the pancreatic duct; for example, blockage by a gallstone or tumor
  • taking certain drugs
  • poor nutrition
  • cystic fibrosis, a hereditary disease causing mucus to build in the lungs
  • inheriting certain genes
  • having high levels of certain fats in the blood

In up to 30 percent of patients, there is no known cause.

Who Is at Risk for Chronic Pancreatitis?

People who abuse alcohol are more at risk of the condition, and men are more likely to have it than women.

What Are the Symptoms of Chronic Pancreatitis?

At first, you may not have any symptoms. Changes in the pancreas can become quite advanced before you begin to feel unwell. When symptoms occur, they may include:

  • pain in your upper abdomen
  • fatty stools, which are loose, pale, and do not flush away easily
  • nausea and vomiting
  • loss of weight
  • symptoms seen in diabetes, such as excessive thirst and fatigue

The pain of chronic pancreatitis is usually just under your ribs and can extend to your back, with episodes lasting for hours or even days. Later in the disease, the pain may become constant. Complications can occur such as:

  • fluid-filled swelling developing in your pancreas
  • fluid accumulating in your abdomen
  • jaundice
  • internal bleeding
  • a blockage in your intestine
  • cancer of the pancreas

Diagnosing Chronic Pancreatitis

In the early stages, the disease is not always easy to diagnose because changes in the pancreas are not obvious enough to show up in blood tests and imaging scans.

You may have blood tests to measure levels of pancreatic enzymes, as well as to check the function of your kidneys and liver. Your doctor may also check your blood sugar levels to see if you have diabetes.

You may need to supply a stool sample to test for levels of pancreatic enzymes and fat.

Your doctor might request X-rays, ultrasounds, CT (computed tomography) or MRI (magnetic resonance imaging) scans of your abdomen to check images of your pancreas. You may have an investigation using an endoscope. An endoscope is a long, thin instrument with a camera, which is inserted through your mouth and passed down to the area where the pancreatic duct opens into your gut.

Treating Chronic Pancreatitis

It is important to give up alcohol, even if this was not the cause of your illness. You may also need to restrict the amount of fat in your diet and to take vitamins, although your doctor will advise you about this. You should avoid smoking, as this can increase your risk of developing cancer of the pancreas.

Medications

Possible medications that your physician may prescribe for chronic pancreatitis include:

  • pain medication
  • artificial enzymes, if your levels are too low to digest food normally
  • insulin, for those who have diabetes
  • steroids, for those with autoimmune pancreatitis

Surgeries

Surgery is not necessary for most people. However, if you have severe pain that is not responding to medication, removing part of your pancreas can sometimes provide relief. Surgery may also be used to unblock your pancreatic duct or to widen it if it is too narrow.

Long-Term Outlook

The outlook for chronic pancreatitis varies according to how severe your disease is and what caused it. Prompt diagnosis and treatment can improve your outlook, so discuss any symptoms with your doctor.

If alcohol was the cause, and you continue to drink, you are at greater risk of developing complication.

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