What is chronic pancreatitis?

Chronic pancreatitis is an ongoing or recurrent inflammation of the pancreas, an organ located behind the stomach.

The pancreas produces digestive enzymes to break down food. It also makes insulin, which regulates the level of glucose in the blood. The digestive enzymes flow into the small intestine. Insulin is released into the blood.

Pancreatitis can be acute or chronic. Acute pancreatitis occurs as one sudden episode. In acute pancreatitis the pancreas can usually return to its normal condition. Chronic pancreatitis means ongoing pancreatitis in which there is permanent damage to the pancreas. The damaged pancreas becomes less able over time to produce normal digestive enzymes and hormones. There may be stones in the pancreas and the pancreatic duct may become dilated

Chronic pancreatitis occurs most commonly after one or more episodes of acute pancreatitis. The disease develops gradually and tends to become worse.

How does it occur?

Chronic pancreatitis may result from:

• Drinking too much alcohol (the most common cause)
• Tropical (Kerala has the highest incidence in the world )
• Too much lipid (fat) in the blood
• Heredity, in rare cases.

What are the symptoms?

Upper abdominal pain and back pain with vomiting are the main symptoms of chronic pancreatitis. 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 progresses, attacks of pain last longer and happen more often. Attacks may last a few hours or as long as several weeks.

Marked weight loss is another common symptom.

As a large area of the pancreas becomes damaged, it produces fewer digestive enzymes for the intestines. As a result, food and nutrients are poorly absorbed. Bowel movements become frequent and foul smelling because of problems with fat absorption. The stools may become oily (steatorrhea)

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

• 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 abdominal pain and how much alcohol you drink.

Tests your health care provider may use to confirm the diagnosis include:

• Blood tests, especially to check your blood sugar and amylase (an enzyme made by the pancreas)
• Ultrasound exam of the pancreas
• CT scan of the pancreas
• ERCP, a way of looking at your pancreas through a slim flexible tube called an endoscope, which is passed through your mouth to where your pancreas and your intestines are connected
• Biopsy, an exam of tissue removed from the pancreas.

How is it treated?

The goals of treatment are:

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

You will need:

• Pain medicine (analgesics)
• A diet of foods that are easy to digest
• Lots of fluids
• Medicine for nausea and vomiting.
• Pancreatic Enzyme supplements
• Antioxidants
• Pancreatic Stenting
• Surgery

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.

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 drain 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 medication prescribed by your health care provider, your chances for improvement are good.

How can I take care of myself?

The most important thing to do is stop drinking all kinds of alcohol. In addition, follow the diet and take the medications 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.