The pancreas is a fish shaped organ located behind the stomach and is responsible for producing enzymes to digest food. The enzymes pass through a tube in the pancreas called the pancreatic duct to the duodenum where food is digested. If there are not enough enzymes, food is not digested and absorbed appropriately. This can lead to malnutrition, diarrhea and weight loss.
Chronic pancreatitis is a chronic inflammation of the pancreas which results in destruction of the pancreatic tissue. Causes of chronic pancreatitis include alcohol use/abuse, gallbladder disease, trauma to the pancreas, smoking, idiopathic (unknown causes) and genetics. It is a permanent condition. The damage is variable and unpredictable. The pancreas is not able to repair itself, so the damage that has been done will not change; however, certain factors may change the amount of continuing damage that is done.
Chronic pancreatitis causes the reduction in the amount of pancreatic enzymes that are available to help digest food which provides essential nutrients to the body and to maintain weight. Some patients may develop diabetes due to the damage of the special tissue in the pancreas that provides insulin (reduction in insulin production).
What are the symptoms?
Symptoms include:
- Upper abdominal pain lasting from hours to days; pain radiating to the back; may get worse with eating and/or drinking alcohol.
- Chronic weight loss despite eating habits that are good and amounts are normal
- Diarrhea, nausea and vomiting
- Fatty, floating or oily stools
- Pale or clay-colored stools
What tests are done for diagnosis of chronic pancreatitis?
- CT scan of the abdomen
- MRI/MRCP
- Blood testing for elevated pancreatic enzymes (acute illness)
- Fecal fat stool testing
- Pancreatic elastase stool test
- Endoscopic ultrasound
What is the treatment for chronic pancreatitis?
- For those with severe pain, or who are losing weight, hospitalization may be necessary. IV fluids, limiting of food/fluid by mouth, and pain medication may be needed.
- The right diet is necessary to keep a healthy weight and reduce the workload of the pancreas. This includes plenty of liquids, limiting fat intake, small frequent meals, abstaining from alcohol and tobacco, limiting caffeine and sometimes pancreatic enzyme supplementation is necessary.
- If insulin production is affected, taking insulin may be necessary.
- If chronic calcific pancreatitis is found (when stones are formed in the pancreas and move to the pancreatic duct, ERCP is sometimes indicated.
- ERCP with sphincterotomy (small incision at the opening of the duct) is often indicated to assist in drainage of pancreatic juices to aid in digestion and absorption of nutrients.
- Sometimes surgery is indicated when medical therapy has failed.
Prevention
Determining the cause of pancreatitis and treating it rapidly may help prevent chronic pancreatitis. Limiting/abstaining from alcohol reduces the risk of getting pancreatitis and limits the damage.