Chronic pancreatitis is a long-term progressive inflammatory disease of the pancreas that leads to permanent breakdown of the structure and function of the pancreas.

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

Treatment

The following treatments are commonly recommended for chronic pancreatitis.

Lifestyle changes

People with chronic pancreatitis will need to undergo some lifestyle changes. These will include:

• Stopping alcohol consumption: Giving up drinking will help prevent further damage to the pancreas. It will also contribute significantly towards relieving the pain. Some people may need professional help to quit alcohol.
• Stopping tobacco use: Smoking is not a cause of pancreatitis, but it can accelerate the progression of the disease.

Pain management

Treatment should not only focus on helping ease the pain symptoms, but also depression which is a common consequence of long-term pain.

Doctors will usually use a step-by-step approach, in which mild painkillers are prescribed, gradually becoming stronger until pain becomes manageable.

Insulin

The pancreas may stop producing insulin if the damage is extensive. The individual is likely to have developed diabetes type 1.

Regular insulin treatment will become part of the treatment for the rest of the person’s life. Diabetes type 1 caused by chronic pancreatitis involves injections, not tablets, because most likely the digestive system will not be able to break them down.

Surgery

Severe chronic pain sometimes does not respond to painkilling medications. The ducts in the pancreas may have become blocked, causing an accumulation of digestive juices which puts pressure on them, causing intense pain. Another cause of chronic and intense pain could be inflammation of the head of the pancreas.

Several forms of surgery may be recommended to treat more severe cases.

Endoscopic surgery

A narrow, hollow, flexible tube called an endoscope is inserted into the digestive system, guided by ultrasound. A device with a tiny, deflated balloon at the end is threaded through the endoscope. When it reaches the duct, the balloon is inflated, thus widening the duct. A stent is placed to stop the duct from narrowing back.

Pancreas resection

The head of the pancreas is surgically removed. This not only relieves the pain caused by inflammation irritating the nerve endings, but it also reduces pressure on the ducts. Three main techniques are used for pancreas resection:

• The Beger procedure: This involves resection of the inflamed pancreatic head with careful sparing of the duodenum, the rest of the pancreas is reconnected to the intestines.
• The Frey procedure: This is used when the doctor believes pain is being caused by both inflammation of the head of the pancreas as well as the blocked ducts. The Frey procedure adds a longitudinal duct decompression to the pancreatic head resection – the head of the pancreas is surgically removed, and the ducts are decompressed by connecting them directly to the intestines.
• Pylorus-sparing pancreaticoduodenectomy (PPPD): The gallbladder, ducts, and the head of the pancreas are all surgically removed. This is only done in very severe cases of intense chronic pain where the head of the pancreas is inflamed, and the ducts are also blocked. This is the most effective procedure for reducing pain and conserving pancreas function. However, it has the highest risk of infection and internal bleeding.

Total pancreatectomy

This involves the surgical removal of the whole pancreas. It is very effective in dealing with the pain. However, a person who has had a total pancreatectomy will be dependent on treatment for some of the vital functions of the pancreas, such as the release of insulin.

Symptoms

Common signs and symptoms of chronic pancreatitis include:

• severe upper abdominal pain that can sometimes travel along the back and is more intense following a meal
• nausea and vomiting, more commonly experienced during episodes of pain

As the disease progresses the episodes of pain become more frequent and severe. Some patients eventually suffer constant abdominal pain.

As chronic pancreatitis progresses, and the ability of the pancreas to produce digestive juices deteriorates, the following symptoms may appear:

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

Eventually, the pancreas may not be able to produce insulin at all, leading to type 1 diabetes, which can produce the following symptoms:

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

Causes

Chronic pancreatitis is usually a complication of recurrent episodes of acute pancreatitis. These can lead to permanent damage in the pancreas.

Acute pancreatitis is caused when trypsin becomes activated within the pancreas. Trypsin is an enzyme that is produced in the pancreas and released into the intestines, where it breaks down proteins as part of the digestive system.

Trypsin is inactive until it has reached the intestines. If trypsin becomes activated inside the pancreas, it will start to digest the pancreas itself, leading to irritation and inflammation of the pancreas. This becomes acute pancreatitis.

Alcohol misuse

Alcohol can cause a process which triggers the activation of trypsin inside the pancreas, as can gallstones.

People who misuse alcohol and develop acute pancreatitis tend to have repeated episodes, and eventually develop chronic pancreatitis.

The repeated bouts of acute pancreatitis eventually take their toll on the pancreas, causing permanent damage, which then becomes chronic pancreatitis.

This is also known as alcoholic chronic pancreatitis.

Idiopathic chronic pancreatitis

When a disease is idiopathic, it has no known cause or reason. Idiopathic chronic pancreatitis accounts for most of the remaining cases.

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