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.

Related Conditions & Treatments

Chronic Pancreatitis

What is chronic pancreatitis?

Your pancreas is an organ with many important functions. It makes enzymes that help you digest food. It also makes insulin to keep your blood sugar levels under control.

Short-term (acute) pancreatitis is a sudden inflammation of your pancreas. This can be very painful. You may have nausea, vomiting, and fever. If your acute pancreatitis doesn’t get better and slowly gets worse, you may have chronic pancreatitis.

What causes chronic pancreatitis?

If you have chronic pancreatitis, the digestive enzymes that would normally travel by tubes inside your pancreas and empty into your upper intestine, become trapped inside your pancreas. This causes pain and scarring. The trapped enzymes slowly cause severe damage to your pancreas.

The most common cause of chronic pancreatitis is drinking a lot of alcohol over a long period of time. Other causes include:

  • An attack of acute pancreatitis that damages your pancreatic ducts
  • A blockage of the main pancreatic duct caused by cancer 
  • Certain autoimmune disorders
  • Cystic fibrosis
  • Hereditary diseases of the pancreas
  • Smoking
  • Unknown cause in some cases

What are the symptoms of chronic pancreatitis?

Early symptoms of chronic pancreatitis are similar to acute pancreatitis. Symptoms are occasional and include:

  • Pain in the upper belly that spreads into the back
  • Pain in the belly that gets worse when you eat or drink alcohol
  • Diarrhea or oily stools that are unusually foul smelling and light colored
  • Nausea and vomiting
  • Severe belly (abdominal) pain that may be constant or that comes back
  • Weight loss

Chronic pancreatitis causes severe damage to your pancreas. This means that your body won't be able to make needed enzymes and hormones. This can result in malnutrition, because you won't be able to digest foods. Chronic pancreatitis can also cause diabetes. This happens because your pancreas can't make insulin. Insulin controls blood sugar.

How is chronic pancreatitis diagnosed?

Your healthcare provider will diagnose you with chronic pancreatitis if:

  • You have a history of acute pancreatitis that comes back or doesn’t get better 
  • You have symptoms of chronic pancreatitis

Your healthcare provider will examine your belly. You will also be asked about your drinking history and any family history of pancreatic disease or cystic fibrosis. Blood and imaging tests are an important part of your diagnosis. They can include:

  • Blood tests.  They will look for high levels of two pancreatic enzymes, amylase and lipase. These may spill into your blood. Other tests may show blockage or damage of your gallbladder. They can also be used to check for certain inherited conditions. You may need vitamin levels and other lab tests.
  • CT scan. This test creates a 3-D image of your pancreas, using X-rays and a computer.
  • Abdominal ultrasound. This test uses sound waves to create an image of your pancreas.
  • Endoscopic ultrasound. This test uses a long, thin tube (endoscope) that is put through your mouth and into your stomach and upper intestine. An ultrasound on the scope makes images of the pancreas and gallbladder ducts.
  • ERCP. This test uses a long, thin tube (endoscope) that is put into the pancreas drainage area if treatment needs to be done.
  • Magnetic resonance cholangiopancreatography. This test makes images using radio waves, a strong magnet, and a computer. In some MRI tests, you will need to have dye injected to show a more detailed image of your pancreas and the ducts of your gallbladder.

How is chronic pancreatitis treated?

Day-to-day treatment includes: 

  • Pain medicine
  • Pancreatic enzyme supplements with every meal
  • Insulin, if you develop diabetes
  • Vitamin supplements, if needed

For acute pancreatitis or a flare-up, you may need to stay in the hospital for treatment. Your exact treatment will depend on the cause of your chronic pancreatitis, how severe the symptoms are, and your physical condition. Acute treatments may include:

  • Feeding through a tube through the nose into the stomach
  • Fasting
  • IV fluids
  • Pain medicines

What are possible complications of chronic pancreatitis?

Chronic pancreatitis damages the insulin-producing cells of the pancreas. This may cause these complications: 

  • Calcification of the pancreas. This means the pancreatic tissue hardens from deposits of calcium salts.
  • Long-term (chronic) pain
  • Diabetes
  • Gallstones
  • Kidney failure
  • Buildup of fluid and tissue debris (pseudocysts)
  • Pancreatic cancer
  • Acute flare-ups that keep coming back

How can I help prevent chronic pancreatitis?

The best way to prevent chronic pancreatitis is to drink only in moderation or not at all. Moderate alcohol drinking is considered to be no more than 1 drink per day for women and 2 drinks per day for men. Quitting smoking is also very helpful. It eases pain and swelling.

Living with chronic pancreatitis

If you have been diagnosed with chronic pancreatitis, your healthcare provider may suggest these lifestyle changes:

  • Don’t drink alcoholic drinks.
  • Drink plenty of water.
  • Don’t smoke.
  • Steer clear of caffeine.
  • Stick to a healthy diet that’s low in fat and protein.
  • Eat smaller and more frequent meals.

When should I call my healthcare provider?

Call your healthcare provider when you start to have short-term (acute) symptoms, including:

  • Severe pain that can’t be eased at home
  • Vomiting and are unable to keep down fluids

Key points about chronic pancreatitis

  • Acute pancreatitis is a sudden inflammation of your pancreas. If your acute pancreatitis doesn’t get better and slowly gets worse, you have chronic pancreatitis.
  • If you have chronic pancreatitis, the digestive enzymes that would normally travel by tubes inside your pancreas and empty into your upper intestine become trapped inside your pancreas.
  • Your healthcare provider will examine your belly. You will be asked about your drinking history and any family history of pancreatic disease or cystic fibrosis.

  • Day-to-day treatment includes pain medicine, pancreatic enzyme supplements with every meal, insulin if you develop diabetes, and vitamin supplements if needed.

  • If you have been diagnosed with chronic pancreatitis, your healthcare provider may suggest lifestyle changes.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your healthcare provider if you have questions.