Overview
The pancreas is an organ in the abdomen. It is responsible for producing digestive juices and certain hormones, including insulin, which is responsible for regulating your blood sugar.
Chronic pancreatitis occurs when the pancreas becomes damaged by long-standing inflammation. Inflammation changes the pancreas' ability to function normally. People with chronic pancreatitis require ongoing medical care to minimize their symptoms, slow the damage to the pancreas, and address any complications that arise. In most cases, treatment controls but does not cure the underlying problem.
What are the symptoms of chronic pancreatitis?
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Pain - the patient may feel pain in the upper abdomen. The pain may sometimes be severe and can travel along the back. It is usually more intense after eating. Some pain relief may be gained by leaning forward or curling into a ball.
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Nausea and vomiting - more commonly experienced during episodes of pain.
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Constant pain - As the disease progresses the episodes of pain become more frequent and severe. Some patients eventually suffer constant abdominal pain.
How is chronic pancreatitis diagnosed?
There are no reliable tests to diagnose chronic pancreatitis. A doctor will suspect the disease because of the patient's symptoms, history of repeated acute pancreatitis flare-ups, or alcohol abuse.
Blood tests may be useful in checking the blood glucose levels, which may be elevated.
Blood tests for elevated levels of amylase and lipase are not reliable at this stage. Amylase and lipase blood levels rise during the first couple of days of pancreatitis, and then settle back to normal after five to seven days. A patient with chronic pancreatitis would have had the disease for much longer.
Doctors need to have a good look at the pancreas in order to diagnose the disease properly. This will most likely involve:
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An ultrasound scan - high frequency sound waves create an image on a monitor of the pancreas and its surroundings.
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A CT (computed tomography) scan - X-rays are used to take many pictures of the same area from several angles, which are then placed together to produce a 3-D image. The scan will reveal changes of chronic pancreatitis.
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MRCP (magnetic resonance cholangiopancreatography) scan - this scan will show the bile and pancreatic ducts more clearly than a CT scan.
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An ERCP (endoscopic retrograde cholangio-pancreatography) scan - an endoscope (thin, flexible tube with a camera at the end) is inserted into the digestive system. The doctor uses ultrasound to guide the endoscope through.
What are the treatment options for chronic pancreatitis?
Lifestyle changes
Patients with chronic pancreatitis will need to undergo some lifestyle changes. These will include:
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Stop drinking - giving up drinking will help prevent further damage to the pancreas. It will also contribute significantly towards relieving the pain. Some people may need professional help to quit alcohol.
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>Stop smoking- smoking is not a cause of pancreatitis, but it can accelerate the progression of the disease.
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Diet - the pancreas is involved in digestion; pancreatitis damages the functions of the pancreas. This means that patients with the disease will have difficulty digesting many foods. Rather than three large meals a day, patients will be advised to change to six small meals. It is also better to avoid fatty meals, i.e. to follow a low-fat diet.
A diet plan will either be drawn up by the doctor, or the patient may be referred to a qualified dietitian.
Depending on the extent of pancreatic damage, patients may also have to take artificial versions of some enzymes to aid digestion. These will ease bloating, make the feces less greasy and foul-smelling, and help the abdominal cramps.
Pain - treatment should not only focus on helping ease the pain symptoms, but also depression which is a common consequence of long-term pain. Doctors will usually use a step-by-step approach, in which mild painkillers are prescribed, gradually becoming stronger until the patient responds.
Insulin - the pancreas may stop producing insulin if the damage is extensive. The patient will have developed diabetes type 1. Regular insulin treatment will become part of the treatment for the rest of the patient's life. Diabetes type 1 caused by chronic pancreatitis involves injections, not tablets because most likely the digestive system will not be able to break them down.
Surgery
Severe chronic pain sometimes does not respond to painkilling medications. The ducts in the pancreas may have become blocked, causing an accumulation of digestive juices which puts pressure on them, causing intense pain. Another cause of chronic and intense pain could be inflammation of the head (top section) of the pancreas. The inflammation aggravates the nerve endings.
Endoscopic surgery - a narrow, hollow, flexible tube (endoscope) goes into the digestive system guided by ultrasound. A devise with a tiny deflated balloon at the end is threaded through the endoscope. When it reaches the duct the balloon is inflated, thus widening the duct. A stent is placed to stop the duct from narrowing back.
Pancreas resection - the head of the pancreas is surgically removed. This not only relieves the pain caused by inflammation which was irritating the nerve endings, but it also reduces pressure on the ducts. Three main techniques are used for pancreas resection:
Endoscopic surgery - a narrow, hollow, flexible tube (endoscope) goes into the digestive system guided by ultrasound. A devise with a tiny deflated balloon at the end is threaded through the endoscope. When it reaches the duct the balloon is inflated, thus widening the duct. A stent is placed to stop the duct from narrowing back.
Pancreas resection - the head of the pancreas is surgically removed. This not only relieves the pain caused by inflammation which was irritating the nerve endings, but it also reduces pressure on the ducts. Three main techniques are used for pancreas resection:
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The Beger procedure - this involves resection of the inflamed pancreatic head with careful sparing of the duodenum, the rest of the pancreas is reconnected to the intestines.
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The Frey procedure - this is used when the doctor believes pain is being caused by both inflammation of the head of the pancreas as well as the blocked ducts. The Frey procedure adds a longitudinal duct decompression to the pancreatic head resection - the head of the pancreas is surgically removed, and the ducts are decompressed by connecting them directly to the intestines.
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Total pancreatectomy - this involves the surgical removal of the whole pancreas. It is very effective in dealing with the pain. However, the patient will be totally dependent on treatment for some of the vital functions of the pancreas, such as the release of insulin.
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Autologous pancreatic islet cell transplantation (APICT) - during the total pancreatectomy procedure a suspension of isolated islet cells is created from the surgically removed pancreas and injected into the portal vein of the liver. The islets cells will function as a free graft in the liver - they will exist in the liver where they produce insulin.
In some cases, surgery is needed to relieve pain by draining an enlarged pancreatic duct. Sometimes, part or most of the pancreas is removed in an attempt to relieve chronic pain.
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