Chronic pancreatitis refers to a long-term (6 months or longer), ongoing condition associated with inflammation in the pancreas, and may present with abdominal pain, digestive issues, or immune deficiencies. Alcoholism is a primary trigger for the disease.
The pancreas is responsible for producing enzymes that aid in digestion and regulate the hormones involved with processing glucose (sugar) in the small intestine. Chronic pancreatitis typically starts out as acute pancreatitis, which is associated with reoccurring, short-term inflammation and pain in the upper abdominal area. When acute pancreatitis is left undetected or untreated, it can become chronic pancreatitis, which can persist for years and worsen over time, causing permanent damage to the organ and may possibly trigger diabetes in some patients.
The incidence of chronic pancreatitis in the US is low, affecting less than 10 people per 100,000. The condition generally affects adults between the age of 30 and 60. Research shows that women are affected more than men, and more than 50% of chronic pancreatitis cases are alcohol related.
Chronic pancreatitis is the result of ongoing inflammation in the pancreas, which usually starts out as acute pancreatitis. The most common causes are long-term alcohol abuse and immune system-related genetic disorders, such as cystic fibrosis. High levels of parathyroid hormones, calcium, or triglycerides in the blood (hyperthyroidism, hypercalcemia, or hypertriglyceridemia, respectively), lupus, gallbladder disease, and pancreatic cancer can also illicit an immune-system response that causes pancreatitis.
Certain types of medications can also cause pancreatitis, including estrogen replacement therapy, which may be why chronic pancreatitis is more common in women than in men. Other medications that have been associated with chronic pancreatitis include corticosteroids, thiazide diuretics, and azathioprine.
A family history of pancreatic disorders may also increase the chances of developing pancreatitis if the patient has inherited a mutation in the trypsinogen gene (PRSS1), which is associated with the trypsin enzyme.
The most common symptoms are upper abdominal pain, indigestion, and abnormal stool. Nausea and vomiting may also occur during episodes of severe abdominal pain. The abdominal pain may last for hours or days, and is worsened by consuming fatty foods or alcohol, and the pain may radiate to the back. Digestive-related symptoms include smelly, oily, or greasy stool that is pale or gray in color, as well as flatulence, uncomfortable bloating, and cramping. Additionally, unexplained weight loss and symptoms of diabetes can be signs of pancreatitis.
If many symptoms are present and the patient has a history of alcohol abuse or an autoimmune disease, a physician may order blood work and a CT (computed tomography), MRI (magnetic resonance image), ultrasound, or ERCP (endoscopic retrograde cholangio-pancreatography) of the abdomen to confirm a diagnosis. High levels of the pancreatic/digestive enzymes amylase and lipase in the blood, may also confirm a diagnosis of pancreatitis.
Treatment for pancreatitis may include changes in lifestyle and diet, as well as pain medication, pancreatic enzyme replacement therapy (PERT), insulin, and temporary hospitalization. If a blockage or gallstone is discovered, surgery will also be involved in the treatment plan. Consumption of alcohol and cigarette smoking is strongly discouraged during treatment, even for mild pancreatitis. A temporary fast may be necessary to clean out the digestive system, followed by a diet of low-fat foods and plenty of water. A pancreas transplant may also be considered a last resort treatment for patients with advanced, severe symptoms.
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