Chronic pancreatitis is a progressive disorder associated with the destruction of the pancreas. The disease is more common in men and usually develops in persons between 30 and 40 years of age. Initially, chronic pancreatitis may be confused with acute pancreatitis because the symptoms are similar.
Causes of Chronic Pancreatitis
Several factors have been identified to cause chronic pancreatitis:
Hereditary pancreatitis – caused by mutations in the trypsinogen gene (PRSS1)
Cystic fibrosis (CF) – caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR).
Atypical CF – caused by mild mutations in CFTR that may only affect the pancreas
Autoimmune pancreatitis – caused by the immune system attacking the pancreas
Severe acute pancreatitis – caused by the destruction of the pancreas in a severe attack with pancreatic necrosis.
Alcohol and smoking. These behaviours appear to be risk factors and usually do not cause chronic pancreatitis. However, if there is an injury to the pancreas from another cause, alcohol consumption and smoking may cause rapid destruction of the pancreas – with the combined effect being much more potent than either one alone.
Blocked pancreatic duct or common bile duct
Familial pancreatitis (runs in the family—with 2 or more immediate family members with a history of pancreatitis)
In many cases, doctors can’t find the cause of pancreatitis. This is called idiopathic pancreatitis.
Most individuals with chronic pancreatitis experience upper abdominal pain, although some have no pain at all. The pain may spread to the back, become worse with eating or drinking and become constant and disabling. In some cases, the abdominal pain goes away as the condition worsens, but this is uncommon.
Other symptoms may include:
upper abdominal pain
oily or fatty stools
clay-colored or pale stools
greasy, foul-smelling stools
weight loss The Pain May:
The pain may:
spread to your back
become constant and severe
become worse after eating
go away as your condition gets worse
People with chronic pancreatitis may not have symptoms until they have complications.
Individuals with chronic pancreatitis frequently lose weight, even when their appetite and eating habits are normal. The weight loss occurs because the body does not secrete enough pancreatic enzymes to digest food, so nutrients are not absorbed normally, leading to malnutrition. Patients who have chronic pancreatitis may have a decreased quality of life due to pain and often require admission to the hospital for treatment of symptoms.
Seek care right away for pancreatitis
Seek care right away for the following symptoms of severe pancreatitis:
pain or tenderness in the abdomen that is severe or becomes worse
nausea and vomiting
fever or chills
shortness of breath
yellowish color of the skin or whites of the eyes, called jaundice
These symptoms may be a sign of
blockage of the pancreas, gallbladder, or a bile and pancreatic duct
Left untreated, these problems can be fatal.
What causes pancreatitis?
The most common causes of both acute and chronic pancreatitis are:
heavy alcohol use
genetic disorders of your pancreas
Other causes include:
infections, such as viruses or parasites
injury to your abdomen
having a procedure called endoscopic retrograde cholangiopancreatography (ERCP) to treat another condition
Diagnosis of Pancreatitis
To diagnose pancreatitis and find its causes, doctors use:
your medical history
a physical exam
lab and imaging tests
A healthcare professional will ask you about your symptoms, and your health history—including medicines you are taking and check your abdomen for pain, swelling, or tenderness.
Healthcare professionals may use lab or imaging tests to diagnose pancreatitis and find its causes. Diagnosing chronic pancreatitis can be hard in the early stages. Your doctor will also test for other conditions that have similar symptoms, such as peptic ulcers or pancreatic cancer.
Treatment for chronic pancreatitis may help relieve pain, improve how well the pancreas works, and manage complications.
Your doctor may prescribe or provide the following:
Medicines and vitamins
Your doctor may give you enzyme pills to help with digestion, or vitamins A, D, E, and K if you have malabsorption. He or she may also give you vitamin B-12 shots if you need them.
Treatment for diabetes
Chronic pancreatitis may cause diabetes. If you get diabetes, your doctor and health care team will work with you to create an eating plan and a routine of medicine, blood glucose monitoring, and regular checkups.
Your doctor may recommend surgery to relieve pressure or blockage in your pancreatic duct, or to remove a damaged or infected part of your pancreas. Surgery is done in a hospital, where you may have to stay a few days.
In patients who do not get better with other treatments, surgeons may perform surgery to remove your whole pancreas, followed by islet auto-transplantation. Islets are groups of cells in your pancreas that make hormones, including insulin. After removing your pancreas, doctors will take islets from your pancreas and transplant them into your liver. The islets will begin to make hormones and release them into your bloodstream.
Your doctor may suggest a nerve block, which is a shot of numbing medicine through your skin and directly into nerves that carry the pain message from your pancreas. If you have stones blocking your pancreatic duct, your doctor may use a procedure to break up and remove the stones.
Treatment for acute or chronic pancreatitis may include a hospital stay to treat dehydration and prescribe pain medicine, antibiotics, and nutrition.
You can’t prevent pancreatitis, but you can take steps to help you stay healthy.
Stop drinking alcohol
Health care professionals strongly advise people with pancreatitis to stop drinking alcohol, even if your pancreatitis is mild or in the early stages. Continuing to drink alcohol when you have acute pancreatitis can lead to:
more episodes of acute pancreatitis
When people with chronic pancreatitis caused by alcohol use continue to drink alcohol, the condition is more likely to lead to severe complications and even death.
Healthcare professionals strongly advise people with pancreatitis to stop smoking, even if your pancreatitis is mild or in the early stages. Smoking with acute pancreatitis, especially if it’s caused by alcohol use, greatly raises the chances that your pancreatitis will become chronic. Smoking with pancreatitis also may raise your risk of pancreatic cancer.
Maintain a healthy weight or lose weight safely
Maintaining a healthy lifestyle and a healthy weight—or losing weight if needed—can help to:
make your pancreas work better
lower your chance of getting gallstones, a leading cause of pancreatitis
prevent obesity—a risk factor for pancreatitis
prevent diabetes—a risk factor for pancreatitis
Patient Story: Mackenzie
One night in my freshman year of high school, I was hanging out with a couple of my girlfriends. What seemed to be a totally normal night for me quickly made a turn for the worse the next morning. I woke up with severe, stabbing abdominal pain that was unlike anything I had felt before.
After receiving blood work and genetic testing, we discovered that I have hereditary chronic pancreatitis, which means I carry a recessive Cystic Fibrosis gene, which can present itself as pancreatitis. I also have a pancreatic divisum, which my doctors believe also contributes to my pancreatitis.