Chronic pancreatitis: Symptoms, causes, and more (original) (raw)

Chronic pancreatitis is a long-term and progressive inflammatory disease of the pancreas. Alcohol use, chemotherapy, and some autoimmune conditions can cause it.

The most common cause of chronic pancreatitis is long-term alcohol use, which causes around 40–70% of all cases. Autoimmune conditions, blockages, chemotherapy, and genetics may also contribute to chronic pancreatitis.

Keep reading to learn more about chronic pancreatitis, including treatment, symptoms, and causes.

The pancreas is a gland in the upper abdomen, behind the stomach and below the ribcage. It produces important enzymes and hormones that help break down and digest food. It also makes insulin to moderate the levels of sugar in the blood.

Chronic pancreatitis may begin as a result of recurring acute pancreatitis, which is a sudden and severe form of the condition. It can persist after the acute phase passes, causing progressive and permanent damage to the pancreas.

The symptoms of chronic pancreatitis can include:

• severe upper abdominal pain that can sometimes travel along the back and may be more intense following a meal
• nausea
• vomiting

For periods of time, people with chronic pancreatitis can have no symptoms. At other times, the pain may be constant. As the condition progresses, the episodes of pain become more frequent and severe.

As the ability of the pancreas to produce digestive enzymes deteriorates, a person may develop:

• bloating
• abdominal cramps
• smelly, greasy stools
• flatulence

Eventually, the pancreas may not be able to produce insulin, leading to type 1 diabetes, which can cause:

• thirst
• frequent urination
• intense hunger
• unintentional weight loss
• tiredness
• blurred vision

Chronic pancreatitis can be a complication of recurring episodes of acute pancreatitis. Factors that may lead to this include:

• Alcohol use: Consuming alcohol can cause a process that triggers the activation of trypsin inside the pancreas. This is also known as alcohol-related chronic pancreatitis, and it is the most common cause for the condition.
• Obstruction: The pancreas has ducts that release enzymes. If they become blocked, this can lead to pancreatitis. Causes of duct obstruction can include gallstones, injury, or cancer.
• Autoimmunity: Autoimmune diseases occur when the body’s immune system attacks healthy tissues, which can include the pancreas.
• Certain medications: Chemotherapy can contribute to chronic pancreatitis, and other drugs may also raise the risk.
• Hypercalcemia: This is when a person has high levels of calcium in their blood. This can lead to gallstones.
• Hyperlipidemia: This is when a person has high levels of lipids or fats in the blood.
• Genetics: People who inherit conditions such as cystic fibrosis or hereditary forms of pancreatitis are more likely to develop chronic pancreatitis.

Some cases of chronic pancreatitis are idiopathic, which means the cause of chronic pancreatitis is unknown. This is more common in countries outside of the West, such as India.

While chronic pancreatitis can develop in anyone, certain factors increase the risk, including:

• chronic alcohol use
• autoimmune conditions
• chronic inflammation
• undergoing chemotherapy
• having certain genetic variants

There is no single test that can diagnose chronic pancreatitis. A doctor may suspect the condition because of the person’s symptoms, history of repeated acute pancreatitis flare-ups, or alcohol use.

Doctors need to have a look at the pancreas in order to diagnose the condition. This may involve:

• an ultrasound scan
• a CT scan
• magnetic resonance cholangiopancreatography
• an endoscopic ultrasound

Blood tests may also be useful in checking the blood glucose levels, which may be elevated.

Treatment for chronic pancreatitis focuses on alleviating symptoms, slowing or stopping damage to the pancreas, and managing any complications.

Lifestyle changes

People with chronic pancreatitis may need to make some lifestyle changes, including:

• avoiding alcohol to prevent further damage to the pancreas and relieve pain
• stopping tobacco use, if relevant
• taking enzymes to replace the ones the pancreas produces
• taking vitamins to fill nutritional gaps in the diet

Diet for chronic pancreatitis

The pancreas is involved in digestion, particularly the digestion of fats. As a result, chronic pancreatitis can impair digestion. Dietary changes are important for reducing symptoms.

A doctor may work with a dietitian to create a customized diet plan. They may recommend:

• eating a low fat diet
• eating several smaller meals instead of fewer, larger ones per day
• focusing on nutrient-dense food

Pain management

To relieve pain, doctors may recommend trying over-the-counter medications. If these do not work, a doctor may recommend prescription medication, including:

• nonsteroidal anti-inflammatory drugs
• pregabalin
• opioids, if all other pain treatments prove ineffective

Living with pain can lead to depression, which may increase the perception of pain. A doctor may prescribe antidepressants to ease both emotional and physical pain.

Insulin

If pancreas damage is extensive, it may stop producing insulin. This can cause diabetes, in which case, people will need insulin therapy.

Surgery

Sometimes, severe pancreas pain does not respond to pain medication. The ducts in the pancreas may have a blockage, causing an accumulation of fluids. Another cause of chronic intense pain could be inflammation of the head of the pancreas.

For these situations, a doctor may recommend:

• Endoscopic surgery: In this procedure, a surgeon inserts a narrow, flexible tube into the digestive system, guided by ultrasound. This allows them to thread a tiny deflated balloon through the endoscope and into the duct. Inflating the balloon widens the duct so that the surgeon can place a stent to keep it open. Surgery relieves symptoms in approximately 60% of people who choose this option.
• Pancreas resection: This involves removing part of the pancreas. This relieves the pain caused by inflammation irritating the nerve endings, and it also reduces pressure on the ducts. While treatment can work well, it is also very risky, with a death rate as high as 10%.
• Total pancreatectomy: This involves the surgical removal of the whole pancreas. It is very effective in dealing with the pain, but will mean a person is dependent on medical treatment to replace the function of the pancreas.
• Autologous pancreatic islet cell transplantation: During total pancreatectomy, doctors may also perform this procedure. It involves taking isolated islet cells from the removed pancreas and injecting them into a vein in the liver. They then produce insulin.

Alternative remedies

Alternative remedies will not cure chronic pancreatitis, but they may help ease symptoms in addition to standard treatments.

• Yoga: Yoga may help a person relax, ease pain, reduce anxiety and depression, and increase appetite.
• Massage: Massage can improve circulation and may help with relaxation.
• Meditation: Meditation may help ease the stress of living with a chronic condition and may help some individuals better cope with their pain.
• Exercise: Exercise can help a person reach or maintain a moderate body weight and may improve mood.
• Acupuncture: Acupuncture is a Traditional Chinese Medicine technique that some people report can help with chronic pain.

Alternative remedies cannot replace medical treatment for chronic pancreatitis. Doing so may allow the disease to progress more rapidly.

There are several ways complications can develop in people with chronic pancreatitis. It may lead to:

• Mental health conditions: Chronic pancreatitis may effect a person’s emotional well-being. Constant or recurring pain that is often severe may cause distress, anxiety, irritability, stress, and depression.
• Pseudocyst: This is a collection of tissue, fluid, debris, pancreatic enzymes, and blood in the abdomen, caused by leakage of digestive fluids escaping from a pancreatic duct that is not working effectively. Pseudocysts do not usually cause any health problems, but they can become infected, cause blockage to part of the intestine, or rupture and cause internal bleeding. If this happens, the cyst will need surgical drainage.
• Cancer: People with chronic pancreatitis are at an increased risk of developing pancreatic cancer.

Yes, in some cases people can prevent chronic pancreatitis. Avoiding alcohol consumption significantly reduces the risk of developing chronic pancreatitis in people with acute pancreatitis. This is especially true for individuals who drink large amounts of alcohol regularly.

It is also important to manage chronic medical conditions that cause inflammation, as this could damage the pancreas.

Chronic pancreatitis is a serious condition that can undermine a person’s overall health and shorten their life span. It can lead to pancreatic cancer, diabetes, and other chronic conditions.

Several medical conditions increase the risk of pancreatitis, including alcohol use disorder, hypercalcemia, and hereditary pancreatitis. Early diagnosis and treatment are critical for prolonging a person’s life and easing their pain.

Individuals with abdominal pain or other symptoms should contact a doctor to discuss treatment options.