Chronic Pancreatitis

Chronic pancreatitis can develop gradually and may be difficult to diagnose, especially early in the disease. It can affect people of all ages.

Chronic pancreatitis can develop for several reasons. In some people, repeated episodes of acute pancreatitis lead to progressive damage and chronic pancreatitis. In others, chronic pancreatitis develops without recognized previous episodes of acute pancreatitis.  

Factors that may increase the risk include:

• Heavy alcohol use and smoking: Both increase the risk of chronic pancreatitis, particularly when they occur together.
• Genetic factors and family history: Certain genetic changes can increase the risk of pancreatitis. A family history of pancreatitis may also suggest an inherited risk. Genetic testing may be recommended for some people.  
• Other causes: Chronic pancreatitis may also be associated with autoimmune pancreatitis and other medical conditions.

In some cases, no specific cause can be identified. This is called idiopathic chronic pancreatitis.

Everyone’s experience with chronic pancreatitis is different.

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Symptoms may include:

• Upper abdominal pain that may spread to the back, worsen after eating, or become constant or severe
• Oily or fatty stools (steatorrhea)
• Diarrhea
• Nausea or vomiting
• Unintentional weight loss

Some people with chronic pancreatitis have little or no pain.

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Chronic pancreatitis can also affect digestion. If the pancreas does not make enough digestive enzymes, the body may have difficulty digesting food and absorbing nutrients. This can lead to weight loss, nutritional deficiencies, and loss of bone density. Pain and other persistent symptoms may also affect quality of life.

Chronic pancreatitis can be difficult to diagnose, particularly in its early stages. Your healthcare professional will consider your symptoms, medical and family history, physical exam, and test results.  

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Tests may include CT or MRI/MRCP to look for changes in the pancreas. In some cases, endoscopic ultrasound (EUS) or tests of pancreatic function may be needed. Blood and stool tests may also be used to look for complications, nutritional deficiencies, or problems with digestion.

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Your healthcare professional may also evaluate for other conditions that can cause similar symptoms.

Treatment focuses on relieving symptoms, supporting digestion and nutrition, managing complications, and improving quality of life.

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Pancreatic Enzyme Replacement Therapy (PERT) and Vitamins: If your pancreas does not produce enough digestive enzymes, your healthcare professional may prescribe PERT to help your body digest and absorb nutrients. Vitamin supplements may also be recommended if testing shows a deficiency.  

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Pain Treatment: Treatment for pain is individualized and may include medicines and other approaches. In some people, a nerve block may provide temporary pain relief.  

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Endoscopic Procedures: Some people with pancreatic duct stones or narrowing may benefit from procedures to improve pancreatic drainage. During an ERCP, a provider may remove pancreatic duct stones, treat a narrowed area, or place a stent.  

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Surgery: Surgery may be considered for some people with chronic pancreatitis to improve pancreatic drainage, or remove damaged areas of the pancreas.

For carefully selected people with severe disease that has not improved with other treatments, total pancreatectomy with islet autotransplantation (TPIAT) may be considered at specialized centers.

Managing chronic pancreatitis often requires attention to nutrition, lifestyle, and potential complications.

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Nutrition: Some people have difficulty digesting and absorbing nutrients. Your healthcare team may recommend working with a registered dietitian or other nutrition professional, particularly if you are losing weight or have nutritional deficiencies.  

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Avoid Alcohol: People with chronic pancreatitis are generally advised to avoid alcohol. Alcohol can contribute to recurrent acute pancreatitis, worsening chronic pancreatitis, and complications.

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Stop Smoking: Smoking can contribute to the development and progression of chronic pancreatitis and increases the risk of pancreatic cancer. If you smoke, your healthcare team can help you find resources to quit.

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Diabetes: Chronic pancreatitis can damage the cells that make insulin and lead to diabetes. If you develop diabetes, your healthcare team will create a treatment plan that may include nutrition changes, medicines or insulin, blood glucose monitoring, and regular checkups.

Regular follow-up with your healthcare team can help monitor your symptoms, nutrition, blood sugar, bone health, and other potential complications.  

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When to Seek Medical Care

Contact your healthcare professional if you develop new, worsening, or persistent symptoms such as abdominal pain, nausea, vomiting, diarrhea, or unexplained weight loss.

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Seek immediate medical attention for severe or sudden abdominal pain, persistent vomiting, fever or chills, yellowing of the skin or eyes (jaundice), difficulty breathing, or signs of dehydration. These symptoms may indicate a serious complication or an episode of acute pancreatitis that requires prompt evaluation.