Chronic Pancreatitis

Condition Basics

Pancreatitis is inflammation of the pancreas. The pancreas is an organ in your belly. It makes digestive enzymes that help your body break down food. It also makes hormones that control sugar, such as insulin.

The digestive enzymes usually stay in one part of the pancreas. But if the pancreas isn't working the way it should, these enzymes may leak into other parts of the pancreas. Or they may leak out of the pancreas. They can irritate it and cause symptoms of pancreatitis. These symptoms include pain and swelling. Other tissues around the pancreas may also get inflamed.

Pancreatitis may happen suddenly (acute). Or it may happen over many years (chronic). If it's chronic, it may cause symptoms that come and go or pain that is constant.

What causes it?

Long-term alcohol use is the most common cause of chronic pancreatitis. Other causes include cystic fibrosis and a recurrent blockage of the ducts that drain the pancreas. Chronic pancreatitis may run in families. And smoking cigarettes also seems to raise the risk for it.

What are the symptoms?

The main symptom is pain in the upper part of the belly. The pain may be mild, and it may feel like it goes through the belly to the back. Sitting up or leaning forward sometimes eases the pain. Pain may be constant or it may come and go.

How is it diagnosed?

Your doctor will do a physical exam and ask you questions about your symptoms and history of pancreatitis. You may have blood tests to see if your levels of pancreatic enzymes are higher than normal. Imaging tests, such as a CT scan, may also be done to look for damage to the pancreas.

How is chronic pancreatitis treated?

With chronic pancreatitis, your doctor will likely recommend eating a low-fat diet and not drinking any alcohol. You may also take medicine to help with pain.

If your pancreas has been badly damaged, you may need to take insulin to help your body control your blood sugar. You also may need to take pancreatic enzyme pills. They can help your body digest fat and protein.

Based on what caused your pancreatitis, you may need a procedure or surgery to treat the cause.

Cause

Long-term alcohol use is the most common cause of chronic pancreatitis. The amount of alcohol needed to cause it may be different for each person.

Other causes include cystic fibrosis and a recurrent blockage of the ducts draining the pancreas. It may run in families. And smoking cigarettes also seems to raise the risk for it.

Chronic pancreatitis may happen after one attack. But it can also happen over many years. It may occur after the earlier cause, such as a blockage, has been treated or after a person has stopped drinking.

In some cases, doctors don't know what causes it.

Prevention

You can lower your risk for chronic pancreatitis by avoiding alcohol. Alcohol use is the most common cause of chronic pancreatitis. It is very important that you not drink any alcohol. If you drink even small amounts, it can cause severe pain and problems. If you drink large amounts of alcohol when you have chronic pancreatitis, it can shorten your life.

You can't fully prevent chronic pancreatitis caused by gallstones. But you may be able to lower your risk for gallstones. To do this, it's important to stay at a weight that's healthy for you, be active, and eat healthy low-fat foods.

If you smoke, you may lower your risk for chronic pancreatitis if you quit.

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Symptoms

The main symptom of chronic pancreatitis is pain in the upper part of the belly (abdomen). Sometimes the pain is mild. It may feel as though it goes through the belly to the back. The pain may come and go, or it may be more constant. Sitting up or leaning forward sometimes eases the pain.

If the pancreas is severely damaged, it may lead to problems with breaking down fat in the intestines. This can lead to symptoms such as greasy stools, poor nutrition, and weight loss.

What Happens

Chronic pancreatitis may happen after one or more episodes of acute pancreatitis. The most common cause is long-term alcohol use.

What happens when you have chronic pancreatitis varies. Pain that continues (persistent) or comes back (recurrent) and other problems often occur. Problems may include flare-ups of symptoms, fluid buildup, and blockage of a blood vessel, the bile duct, or the small intestine.

If much of the tissue in the pancreas has died, you may not get enough nutrients. So you may become malnourished. This happens because the pancreas no longer makes the enzymes needed to digest fat and protein. So fat is released into your stool. This condition, called steatorrhea, causes loose, pale, very foul-smelling stools. The stools may float in the toilet bowl.

If the damaged pancreas stops making enough insulin, you also may get diabetes.

Chronic pancreatitis raises your risk for pancreatic cancer.

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When to Call a Doctor

Call your doctor now if you have:

• Severe belly pain with vomiting that does not go away after a few hours.

Call your doctor if you have:

• Mild to moderate pain that does not improve with home treatment after a couple of days.

Exams and Tests

If your doctor thinks that you have chronic pancreatitis, they will ask questions about your symptoms and history of pancreatitis and do a physical exam. You may have blood tests to see if your levels of pancreatic enzymes are higher than normal.

Your doctor may also do a CT scan of your belly to look for scarring and other signs of damage of the pancreas. Sometimes a special MRI test called magnetic resonance cholangiopancreatography (MRCP) is used.

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Treatment Overview

People who have chronic pancreatitis also may have acute episodes. These are treated the same as any episode of acute pancreatitis. With an acute episode, you might need treatment in a hospital. You may get pain medicine and fluids through a vein (I.V.).

For chronic pancreatitis, treatment also includes:

Avoiding alcohol.

Alcohol use is the most common cause of chronic pancreatitis. It is very important that you not drink any alcohol. If you drink even small amounts, it can cause severe pain and problems. If you drink large amounts of alcohol when you have chronic pancreatitis, it can shorten your life.

Managing pain.

If you have chronic pancreatitis, you may deal with ongoing pain. To treat pain, it helps to avoid alcohol, eat a low-fat diet, and use pain medicine. In some cases, you can take enzyme pills to help your pancreas rest.

Taking enzyme pills.

In advanced chronic pancreatitis, your body may not absorb fat. This causes loose, oily, very foul-smelling stools (steatorrhea). You may lose weight. This happens because your pancreas may not make enough of the enzymes you need to digest fat and protein. Pancreatic enzyme pills can replace the missing enzymes.

Taking antibiotics.

You may need antibiotics if you get an infection.

Using insulin.

You may need insulin if your pancreas has stopped making enough of it.

Having surgery.

Surgery is avoided when possible. That's because the pancreas is damaged easily. But you may need surgery or another procedure in some cases, such as when there's an infection or if stones are blocking the pancreatic duct.

Your doctor will want to see you on a regular schedule. Your doctor will make sure that your pain medicine is helping you. The doctor will also check for problems (complications) from chronic pancreatitis. Problems may include symptoms that keep flaring up, fluid that builds up, a blockage in the bile duct, and in rare cases, a blocked blood vessel or small intestine. Chronic pancreatitis also raises your risk for pancreatic cancer.

Making lifestyle changes to help manage chronic pancreatitis may seem hard. But when you can make a plan, work with your doctor, and get support from family and friends, these changes are possible.

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Self-Care

If you have chronic pancreatitis caused by alcohol use, you'll need to quit drinking to reduce severe pain and other problems that can happen (complications). If you drink large amounts of alcohol when you have chronic pancreatitis, it can shorten your life.

It's not clear how your diet might affect pancreatitis. But doctors recommend that you eat low-fat foods and stay at a healthy weight.

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Medicines

You may need medicines to treat chronic pancreatitis. They may include:

Pain medicine.

Over-the-counter medicines like acetaminophen or ibuprofen may be tried first. If these don't work to help your pain, your doctor may prescribe other pain medicines.

Pancreatic enzyme supplements.

In advanced chronic pancreatitis, the pancreas may stop making the enzymes needed to digest fats, proteins, and carbohydrates. Enzyme supplements that you can take with meals can help the body digest fats. This helps you keep the nutrients from your food and gain weight.

People who are allergic to pork or who don't eat pork for other reasons should not take these enzymes. They are made from pork protein.

Insulin.

Advanced chronic pancreatitis can lead to diabetes if the part of the pancreas that makes insulin becomes damaged.

Be safe with medicines. Read and follow all instructions on the label.

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