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Chronic Pancreatitis

WHAT IS CHRONIC PANCREATITIS?

Chronic pancreatitis is a long-lasting inflammation in the pancreas that comes and goes over time. Inflammation changes the ability of the pancreas to function normally, causing permanent damage. Scarring of the pancreatic tissue often occurs. In severe cases, it may cause the pancreas to stop making enzymes and insulin.

At Loma Linda University Health, we are uniquely qualified to treat chronic pancreatitis. The board-certified specialists at our Digestive Disease Center are leaders in the treatment of pancreatic conditions.

WHAT ARE THE SYMPTOMS OF CHRONIC PANCREATITIS?

Although pancreatitis symptoms may vary, symptoms may include:

  • Severe belly/abdominal pain that may spread to the back and chest
  • Nausea
  • Vomiting
  • Rapid heart rate
  • Fever
  • Swelling, soreness or tenderness in the upper belly/abdomen
  • Low blood pressure
  • Yellowing of the skin and eyes (jaundice)

Because the symptoms of pancreatitis may look like other health problems, they should always be evaluated by a healthcare provider.

WHAT CAUSES CHRONIC PANCREATITIS?

Chronic pancreatitis is most often caused by:

  • Alcohol abuse
  • Gallstones, as they block the pancreatic duct so the enzymes cannot leave the pancreas

Other contributing causes may include:

  • Lifestyle, namely obesity and smoking
  • High triglycerides
  • High levels of calcium in the blood
  • Certain medications: estrogens, steroids, thiazide diuretics
  • Infections: mumps, hepatitis A or B, salmonella
  • Injury or surgery on the abdomen
  • Tumor
  • Cystic fibrosis
  • Certain genetic defects or inherited traits
  • Congenital abnormalities in the pancreas
  • Trauma to the pancreas
  • Repeat attacks of acute pancreatitis

Sometimes, the cause of chronic pancreatitis is unknown.

HOW IS CHRONIC PANCREATITIS DIAGNOSED?

Pancreatitis is diagnosed by medical history, a physical exam and diagnostic testing. Diagnostic testing may include:

  • Blood tests, to look for elevated pancreatic enzymes
  • Abdominal X-ray, to view images of internal tissues, bones and organs
  • Ultrasound, to see internal organs and and evaluated blood flow
  • CT scan or MRI, to look for inflammation in the pancreatic gland
  • Magnetic resonance cholangiopancreatography (MRCP), which uses MRI to make detailed images of the pancreas, gallbladder and biliary ducts
  • Endoscopic ultrasound (EUS), which evaluates the pancreas using a thin tube with an ultrasound attached (patients are sedated, as the tube is inserted through the mouth)
  • Endoscopic retrograde cholangiopancreatography (ERCP), which uses a thin tube with a camera attached to reach the small intestine and pass a catheter into the bile duct, removing any gallstones that are causing the pancreatitis (patients are sedated, as the tube is inserted through the mouth)

HOW IS CHRONIC PANCREATITIS TREATED?

People with chronic pancreatitis require ongoing medical care to minimize symptoms, slow damage to the pancreas and address any complications. Commonly prescribed treatments for chronic pancreatitis include:

  • Pain management - Pain management begins with over-the-counter medication (such as acetaminophen or ibuprofen). If this is not effective, mild opioids (such as codeine) may be prescribed. If mild opioids do not relieve pain, strong opioids (such as morphine) may be prescribed.
  • Antioxidant therapies - A mixture of antioxidants containing vitamin C, vitamin E, selenium and methionine may be given as a supplement in combination with traditional therapy.

Surgical treatment for chronic pancreatitis includes:

  • Lateral pancreaticojejunostomy - Also known as a modified Puestow procedure, this can relieve pain in up to 80% of patients.
  • Classic Whipple procedure - This surgery can remove inflammation and masses on the head of the pancreas; however, there are high risks associated with it. When possible, the less risky modified Whipple procedure may be recommended.
  • Modified Whipple procedure - This procedure saves more tissue than the classic Whipple procedure. It can be effective for pain relief and resuming daily activity.
  • Total Pancreatectomy with islet auto-transplantation (TP-IAT) - For some patients whose pain remains crippling despite standard medical and surgical approaches, TP-IAT yields significant relief of symptoms. However, it is not a cure.
  • Bilateral Thoracoscopic Splanchnicectomy - This surgical resection of one or more of the splanchnic nerves may be an option for sufferers of constant chronic pancreatitis pain. Although not widely available, it may be performed by a thoracic surgeon when necessary.

Chronic pancreatitis may be reduced in severity by lifestyle changes, such as:

  • Quitting smoking
  • Eliminating alcohol  
  • Eating small, low fat meals
  • Aiding digestion with enzyme supplements
  • For those who have diabetes, following your provider’s insulin instructions

At Loma Linda University Health, our Digestive Disease Center treats more pancreatic disorders than any medical center in the region. Our specialists are board-certified in gastroenterology and surgery with advanced training and experience in this area. Our gastroenterologists and surgeons work together to treat complex pancreas and biliary conditions with a single team approach.

WHAT ARE THE COMPLICATIONS OF CHRONIC PANCREATITIS?

Complications of chronic pancreatitis include long-term problems with:

  • Constant abdominal pain
  • Inability to digest food properly
  • Malnutrition and inability to absorb nutrients
  • Thinning and weekend bones that can lead to bone fractures
  • Unwanted weight loss
  • Diabetes
  • A collection of fluid around the pancreas (pseudocyst)
  • Narrowing or blockage in a bile or pancreatic duct
  • Leakage from the pancreatic duct
  • Thinning and weakened bones that can lead to bone fractures
  • Permanent damage to the pancreas
  • Pancreatic cancer, especially in those with both diabetes and pancreatitis
  • Heart, lung, or kidney failure

Although less common than is the case with acute pancreatitis, if left untreated, chronic pancreatitis can lead to necrotizing pancreatitis, and this can ultimately lead to death.

WHO IS AT RISK FOR CHRONIC PANCREATITIS?

People most at risk for chronic pancreatitis include:

  • Men between ages 30 and 40 (although chronic pancreatitis can occur in women)
  • Those who have consumed alcohol heavily for a long period of time
  • Those with certain hereditary conditions, such as cystic fibrosis
  • Those who suffer from gallstones
  • Those with conditions such as high triglycerides and lupus

NEXT STEPS

  • Make healthy choices. Lifestyle plays a major role in the prevention of pancreatitis. If you are at risk because of any of the lifestyle factors listed here, take steps to change those habits immediately
  • Seek medical intervention. If you are experiencing symptoms of chronic pancreatitis, seek medical attention right away. Being proactive is important, and it starts with a physician evaluation. To request an evaluation at Loma Linda University Health, contact your provider or schedule the appointment through MyChart.