Chronic Pancreatitis

Chronic pancreatitis is a long-term disease that is related to a slow fading of exocrine pancreatic functions. It is a completely different condition than the acute pancreatitis.

Causes

The most common cause is chronic alcoholism. The alcohol directly damages the pancreatic cells, they succumb to necrosis and they are replaced by connective tissue. Chronic pancreatitis also occurs in cystic fibrosis, as an autoimmune disorder and in some other rare genetics-related conditions. Frequently recurring bouts of acute pancreatitis (no matter its primary cause) can of course also gradually lead to development of chronic pancreatitis.

Symptoms

The condition manifests with intermittent bouts of abdominal pain and digestive problems. The pain often occurs shortly after a meal; the affected person loses weight and suffers from diarrhea. The problem is caused by a low activity of pancreatic enzymes, which leads to malabsorption of nutrients including fats. The stool is oily, bulky and smells unpleasantly due to the high amount of undigested fats. Advanced stages of chronic pancreatitis may be accompanied with decreased activity of pancreatic cells producing hormones including insulin and the patient may express symptoms of diabetes, which is similar to type 1 diabetes.

Diagnosis

Personal history (risk factors, symptoms) and physical examination focused on the abdomen should begin the diagnostic approach. Blood tests may show decrease of serum level of pancreatic enzymes but this examination is very inaccurate. Imaging methods such as abdominal ultrasound or computed tomography can help us to visualize the pancreas and its surroundings. Pancreatic duct and biliary tree are examinable by ERCP or less invasive MRCP.

As the chronic pancreatitis increases the risk of pancreatic cancer, the patients should be regularly checked by a gastroenterologist including regular abdominal ultrasound.

Treatment

The patient must not drink alcohol and he must adhere to proper diet with reduced intake of fat. It is possible to administer the pancreatic enzymes in form of oral capsules that are dissolved in the small intestine and replace the missing enzymes of the patient. When the pancreas is unable to produce insulin, it must be used regularly as in classical cases of type 1 diabetes. Some painful forms of chronic pancreatitis are solved surgically by removing part of the gland and allowing proper drainage of pancreatic juice into the intestine.