Chronic Pancreatitis – A Progressive Disorder of the Pancreas

Chronic pancreatitis is a progressive disorder of the pancreas that causes destruction of the pancreas. Initially chronic pancreatitis is often confused with acute pancreatitis because the symptoms are similar. The most common symptoms are diarrhea and upper abdominal pain. The pain may radiate directly through to the back. As the disease becomes more chronic, patients develop malnutrition and weight loss. If the pancreas becomes destroyed in the later stages, patients may develop diabetes mellitus.

The diagnosis of chronic pancreatitis is difficult because routine blood studies (such as amylase and lipase levels) do not necessarily show elevations. The most important clue to a proper diagnosis is an accurate medical history. There are many diagnostic tests that can be used for chronic pancreatitis. The evaluation should begin with a plain film of the abdomen. The finding of pancreatic calcification is virtually diagnostic of chronic pancreatitis but quit often this is not found. There are several other tests that can be used to diagnose chronic pancreatitis:

• Ultrasonography This method uses high-frequency sound waves that are above the human audible range. An instrument sends sound waves into the patient’s abdomen, and the echoes that the sound waves produce as they bounce off internal organs creates a picture called a sonogram.
• CT scanning (Computed Tomography) This method of testing involves the use of an x-ray machine that is linked to a computer. The patient lies on a bed that passes through a hole, and the machine moves along the patient’s body, simultaneously taking multiple x-rays. The computer then pieces the x-rays together to produce detailed pictures.
• ERCP (Endoscopic retrograde cholangiopancretography) This method takes x-rays of the common bile duct and the pancreatic ducts. The doctor passes a long, flexible tube called an endoscope down the throat, through the stomach, and into the small intestine. The doctor then injects dye into the ducts and takes x-rays.
• EUS (Endoscopic Ultrasound) This is a test that combines ultrasound (sound waves) with an endoscope. The doctor places the tube (endoscope) into the stomach and the ultrasound machine (which is on the endoscope) is used to direct sound waves to the pancreas.
• MRI (Magnetic Resonance Imaging) This imaging uses magnetic fields and radio waves to generate images. The patient lies on a bed that is moved into the tunnel of the scanner. The scanner houses a powerful magnet that surrounds the cylinder. The magnetic field and radioactive waves cause the atoms in the body to emit tiny signals. The computer converts the signals into an image.

The treatment for chronic pancreatitis depends on the symptoms. Most therapies focus on pain management and nutritional support. Oral pancreatic enzyme supplements are utilized to aid in the digestion of food. There is research that shows that they may also be helpful in reducing pain. Patients who develop diabetes require insulin to control the blood sugar. In patients using alcohol, the avoidance of alcohol is central to therapy. A diet low in fat is necessary and sometimes it is easier for the patient to eat more frequently in much smaller portions.