Chronic pancreatitis

Chronic pancreatitis refers to severe or recurring inflammation of the pancreas. This large gland is located in the upper part of the abdomen, behind the stomach. It produces digestive enzymes and hormones such as insulin and glucagon, which are responsible for controlling blood sugar.

This long-term inflammation causes permanent damage to the pancreas, leading to digestive problems and nutritional deficiencies.

Causes of chronic pancreatitis include:

• alcohol abuse (responsible for about 90% of cases)
• gallstones
• some medicines
• an inherited abnormality in the shape of the ducts (tubes) of the pancreas
• a mutation in a particular gene

In chronic pancreatitis, the pancreas cannot produce and deliver enough digestive enzymes to the small intestine. Over time, this leads to worsening nutritional deficiencies. Interference with hormone production, particularly of insulin, can lead to diabetes.

Symptoms of chronic pancreatitis

It may take many years of alcohol abuse before symptoms of chronic pancreatitis appear.

Unexplained abdominal pain, sometimes accompanied by nausea and vomiting, is a common symptom. Nutritional deficiencies and diabetes can lead to weight loss and symptoms of vitamin deficiency, especially of vitamin B12. Bowel movements may become yellow, smell especially bad, and float because they contain undigested fat.

Diagnosing chronic pancreatitis

A person's description of his or her symptoms and medical history are important for diagnosing chronic pancreatitis.

Tests to measure the level of pancreatic enzymes in the blood can help make the diagnosis. Blood tests for the levels of various nutrients may help determine the severity of the problem.

Imaging tests such as ultrasound, endoscopic retrograde cholangiopancreatography, and a CT scan may be needed to diagnose chronic pancreatitis.

Treating chronic pancreatitis

One part of treatment aims to stop the underlying problem that is causing chronic pancreatitis. If alcohol abuse is the cause, it is essential to stop drinking alcohol. If the underlying cause is an abnormality in the shape of pancreatic ducts, a procedure to fix it may help.

Other treatments include

• medications to relieve pain and inflammation, such as nonsteroidal anti-inflammatory drugs like ibuprofen, naproxen, and others
• pancreatic enzymes taken as a medicine to help digest food
• insulin, if needed

Repeated attacks of acute pancreatitis can cause large cysts (pseudocysts) that contain digestive enzymes to form in the pancreas. An operation or other procedure may be needed to drain a pancreatic pseudocyst or to remove part or all of the pancreas.