About Chronic Pancreatitis
Chronic pancreatitis is an inflammatory condition that involves progressive and irreversible scarring, structural changes, and damage to the pancreatic tissue as well as permanent impairment of pancreatic function. Early chronic pancreatitis may begin with recurrent bouts of chronic abdominal pain with normal or mildly elevated pancreatic enzymes. Over time, patients experience permanent structural and functional pancreatic impairment which results in:
- Exocrine insufficiency - deficiency in pancreatic enzyme production that results in impairment of digestion.
- Endocrine insufficiency - deficiency in insulin production that results in elevated levels of blood sugar.
The primary and most common symptom associated with chronic pancreatitis is severe pain (experienced by at least 75% of patients), either episodic or intractable (unceasing), which significantly impacts quality of life. The pain may actually abate as the condition worsens and the pancreas ceases to function. Progressive chronic pancreatitis may also be associated with the development of complications (outlined below), such as, progressive fibrosis which may entrap nerves and contribute to pain levels and calcification of pancreatic tissue.
There are six different types of chronic pancreatitis based on the underlying cause of the inflammation:
- Toxic or metabolic pancreatitis - caused by excessive alcohol consumption or smoking
- Idiopathic pancreatitis - the exact cause cannot be identified
- Hereditary pancreatitis - caused by a genetic mutation (defect)
- Autoimmune pancreatitis - caused by an underlying autoimmune disorder
- Recurrent pancreatitis - recurring bouts of acute pancreatitis typically presenting with abdominal pain
- Obstructive pancreatitis - caused by an obstruction in the main pancreatic duct.
Most cases of chronic pancreatitis are diagnosed in people between the ages of 40-60. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the worldwide incidence of chronic pancreatitis is estimated to be approximately 1.6 to 23 cases per 100,000 people and is thought to be rising, in part, due to increasing alcohol consumption. The incidence of chronic pancreatitis in all Western countries is approximately 6 per 100,000 people. It affects men four times as often as women, although the rate of chronic pancreatitis in women is rising.
Pain is a predominant feature in up to 90% of patients with alcohol-induced pancreatitis and in up to 50% of patients with other types of pancreatitis. Chronic pancreatitis-related pain is responsible for up to 90,000 admissions to hospitals in the U.S. per year, and the pain has a strong impact on quality of life. Pain associated with acute pancreatitis initially is imited to the duration of the individual episode. Some people however, may experience chronic abdominal pain following recurrent episodes of acute pancreatitis with its progression to chronic pancreatitis.
As noted above, since the pancreas plays a crucial role in digestion through both the endocrine and exocrine systems, the hallmark feature of chronic pancreatitis is permanent damage to both of these functions. As a result, malnutrition and diabetes are significant complications associated with chronic pancreatitis. Moreover, because eating provokes pain in many patients, they respond by eating less in order to avoid the pain. Many doctors, therefore, recommend that patients suffering with chronic pancreatitis be screened at regular intervals for both malnutrition as well as diabetes.
In addition to pain, there are several complications that may occur in patients with chronic pancreatitis, including:
- Diabetes mellitus
- Nutrient malabsorption - If pancreatic enzyme secretions are reduced more than 90%, absorption of nutrients is affected which can lead to weight loss and steatorrhea (foul-smelling, fatty stools)
- Deficiency of Vitamins A, D, E, K, and/or B12
- Calcifications - small deposits of mineral salts collect in the pancreas and can lead to destruction and hardening of the tissue; can develop up to ten years after the first attack of pancreatitis and are removed surgically, if needed
- Pseudocyst formatin - a collection of fluid within a well-defined capsule that may develop with acute or chronic pancreatitis that can cause complications such as infection, rupture, obstruction of ducts, or bleeding.
- Pancreatic duct strictures
- Bile duct obstruction
Long-standing, pre-existing chronic pancreatitis in general, and hereditary pancreatitis in particular, are considered high risk factors for developing pancreatic cancer. There is a 15-fold increase in the risk of pancreatic cancer for people with chronic pancreatitis, especially for those with alcoholic pancreatitis and a 40 to 50-fold increase for patients with hereditary pancreatitis.
Chronic pancreatitis is difficult to diagnose in many patients since its early symptoms can be mistaken for many other digestive or gastric conditions. It is estimated that some patients are not diagnosed until up to five years after onset of symptoms because the pain patterns are so variable. Chronic pancreatitis may be "clinically silent" in some people until approximately 90% of the pancreas has been affected.
A typical diagnostic evaluation for chronic pancreatitis includes:
- Physical examination
- Evaluation of pancreatic function
- Evaluation of pancreatic structure
If chronic pancreatitis is suspected, additional tests may be performed such as genetic studies to rule out hereditary pancreatitis and immunological studies to rule out autoimmune pancreatitis.
There are several other medical conditions which may present with symptoms similar to chronic pancreatitis and which must be ruled out before a final diagnosis of chronic pancreatitis is established. These conditions include:
- Acute pancreatitis
- Pancreatic cancer
- Peptic ulcer disease
- Gallstones
- Irritable bowel syndrome
- Endometriosis
- Obstruction of the common bile duct
- Renal insufficiency
The goals of therapy for chronic pancreatitis are pain management, restoration of pancreatic function whenever possible, and the prevention, detection and management of complications.
The treatment of chronic pancreatitis is determined by several factors such as the cause, the extent and location of damage to the pancreas, the presence or absence of symptoms, complications, and the general health of the patient. When symptoms are mild or absent ("silent pancreatitis") no treatment is indicated.
Treatment options for symptomatic chronic pancreatitis include:
- Pain relief medications
- Endoscopic procedures
- Surgery
- Nerve blocks
- Restoration of pancreatic function and nutritional status
- Management of complications if they occur
- Total abstinence from alcohol and tobacco
The Medifocus Guidebook on Chronic Pancreatitis is a unique, comprehensive patient education resource that contains vital information about Chronic Pancreatitis that you won't find anywhere else in a single resource. The Guidebook will answer many of your questions about this condition that your healthcare provider may not have the time to answer. To learn more about the Guidebook, please click here
