Everything You Need To Know about Chronic Pancreatitis...

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Medically reviewed by Kumkum Sarkar Patel, MDMedically reviewed by Kumkum Sarkar Patel, MDChronic pancreatitis is a progressive inflammatory condition that damages the pancreas. The pancreas is a pear-shaped organ behind the stomach that produces enzymes to support digestion and hormones to regulate blood sugar levels. Long-term inflammation from chronic pancreatitis causes permanent damage and scarring of the pancreas, affecting its function and leading to symptoms like upper abdominal pain, stool changes, nausea, and vomiting.Chronic pancreatitis is a rare disease affecting about 200,000 people in the United States and one million people worldwide. Genetic and environmental factors play a role in the development of chronic pancreatitis, but in many cases, the cause is unknown (idiopathic).Treatment, including lifestyle modifications, medications, and surgery, focuses on pain management, improving the function of the pancreas, and preventing complications.Chronic Pancreatitis Symptoms The hallmark symptom of chronic pancreatitis is upper abdominal pain, which may come and go, lasting for hours or days at a time. The pain may radiate to your back or worsen after drinking alcohol or eating.As the condition progresses, upper abdominal pain may become constant and severe, though some people may notice the pain goes away as the pancreas sustains more damage. A damaged pancreas has difficulty producing enough digestive enzymes to break down nutrients from food, leading to symptoms like: NauseaVomiting DiarrheaOily or greasy stoolPale or clay-colored stoolFoul-smelling stoolWeight loss CausesChronic pancreatitis develops when long-term inflammation damages the pancreas, leading to permanent damage and scarring (fibrosis). This damage impairs the pancreas' ability to produce and release digestive enzymes that help the body digest and absorb nutrients from food, as well as insulin and glucagon, which help regulate blood sugar levels. Heavy alcohol consumption is the leading cause of chronic pancreatitis. In the U.S., about 50% of all chronic pancreatitis cases are the result of excessive alcohol intake. Long-term alcohol use causes inflammation that damages the pancreatic ducts, thickens pancreatic fluids, and causes early activation of digestive enzymes in the pancreas, which contribute to permanent damage to the pancreas. While heavy alcohol use is the leading cause of pancreatitis, less than 5% of those who consume high amounts of alcohol develop chronic pancreatitis, suggesting several factors play a role in the development of the condition. Other possible causes of chronic pancreatitis include:Recurrent acute pancreatitis: About 36% of people with a history of recurrent acute pancreatitis—repeated bouts of sudden inflammation of the pancreas—develop chronic pancreatitis. Genetic variants: Inherited changes in the trypsinogen (PRSS1) gene can cause changes in how the pancreas produces certain enzymes, leading to hereditary pancreatitis that may develop into chronic pancreatitis. Cystic fibrosis, a genetic condition that affects the pancreas and other organs, can also cause chronic pancreatitis.Immune system dysfunction: Chronic pancreatitis can develop when the immune system mistakenly attacks the pancreas, leading to long-term inflammation. It may occur on its own or in combination with other autoimmune disorders, such as systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome.Blocked pancreatic duct: Gallstones or tumors that block one or more pancreatic ducts can lead to chronic inflammation and pancreatitis. Risk FactorsSeveral factors can increase your risk of developing pancreatitis, including:Alcohol use and smoking: Long-term heavy alcohol use is the leading risk factor for chronic pancreatitis. Smoking can worsen pancreatic inflammation and rapidly damage the pancreas in people who drink and smoke. Sex: People assigned male at birth are more likely to develop chronic pancreatitis than people assigned female at birth. Age: Chronic pancreatitis most commonly develops in people between the ages of 30-40. Family history: Having a family member with a history of acute or chronic pancreatitis may increase your risk. Certain medications: Sulfonamides (a class of antibiotics), thiazides (a class of diuretics), and Azasan (azathioprine, an immunosuppressant), are associated with an increased risk of chronic pancreatitis.Diagnosis Diagnosing chronic pancreatitis can be challenging because it is rare, and symptoms often mimic those of other conditions, such as peptic ulcers, gallstones, or pancreatic cancer. Healthcare providers use a combination of medical history, symptom review, physical examination, and diagnostic tests to provide an accurate diagnosis. Your healthcare provider will likely begin by reviewing your medical history and asking about your symptoms. They may ask about the medications you take, your alcohol consumption habits, and whether you have a family history of pancreatic conditions. During the physical exam, your healthcare provider will palpate (touch) your abdomen to check for swelling, pain, and tenderness. Diagnostic tests, including blood tests and imaging scans, can confirm a chronic pancreatic diagnosis. These tests may include: Blood tests: Blood tests can measure the levels of pancreatic enzymes in your blood. Elevated levels can indicate pancreatic inflammation or damage. Other blood tests may identify vitamin/nutritional deficiencies common in people with chronic pancreatitis. Stool test: A fecal fat test measures the amount of fat in your stool to determine whether your pancreas is producing enough enzymes to digest dietary fats properly.Imaging tests: Imaging scans, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans and ultrasounds, create detailed images of your pancreas to detect problems such as inflammation, scarring, structural abnormalities, or blockages in the ducts. Endoscopic ultrasound: This specialized procedure uses a thin, flexible tube with a camera and ultrasound to examine the pancreas and pancreatic and bile ducts for inflammation, scarring, and blockages.Magnetic resonance cholangiopancreatography (MRCP): This produces high-resolution images of the pancreatic ducts and surrounding structures to detect blockages and structural changes.Chronic Pancreatitis TreatmentThere is no cure for chronic pancreatitis, so treatment focuses on managing pain, improving pancreatic function, and preventing complications. Treatment approaches vary, depending on the severity of your symptoms. Lifestyle ModificationsCertain lifestyle habits can help improve the function of your pancreas, manage symptoms, and help slow the progression of the disease. Consider making the following lifestyle changes: Modify your diet: Following a low-fat diet and eating small, frequent meals can help reduce pain and complications.Avoid alcohol: Avoiding alcohol is one of the best ways to prevent further damage to your pancreas.Avoid smoking: Smoking can worsen inflammation and cause more damage to the pancreas. Quitting smoking can help protect your pancreas and overall health.Exercise regularly: Regular physical activity can help maintain a healthy body weight, improve how your body uses insulin, and reduce inflammation. Manage stress: Stress can increase inflammation and may worsen chronic pancreatitis symptoms. Yoga, meditation, or engaging in your favorite hobbies can help manage stress and reduce inflammation.MedicationsSeveral medications can help manage chronic pancreatitis, including:Pain relievers: Pain relievers like Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) may help with mild pain. For more severe pain, your healthcare provider may prescribe stronger medications, such as opioids.Antidepressants: Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can help manage chronic pain in combination with narcotic pain relievers.Pancreatic enzyme replacement therapy (PERT): Enzyme supplements mimic natural pancreatic enzymes to support the digestion and absorption of fats and proteins. Insulin: Diabetes is common in people with chronic pancreatitis. Your healthcare provider may prescribe insulin to help keep your blood sugar (glucose) levels within a healthy range. Medical Procedures and Surgeries In some cases, medical procedures or surgery may be necessary to address complications of chronic pancreatitis or manage severe, uncontrollable pain. These include:Nerve block: Stops the nerves in the celiac plexus—a bundle of nerves in the upper abdomen—from sending signals to the brain to help manage severe pain in people with chronic pancreatitis Endoscopic retrograde cholangiopancreatography (ERCP): A minimally invasive procedure that uses an endoscope to access the pancreatic ducts to remove stones (blockages) or place stents to open the ductsExtracorporeal shock wave lithotripsy (ESWL): Uses shock waves to break gallstones or pancreatic stones into smaller, easier-to-pass or remove fragmentsCholecystectomy: Removal of the gallbladder if gallstones are causing pancreatitis painWhipple procedure (pancreaticoduodenectomy): Involves removing the head of the pancreas, cysts in the bile duct, and scarring on the pancreas Puestow procedure (longitudinal pancreaticojejunostomy): Drains an inflamed pancreatic duct without removing the pancreas or surrounding tissueFrey procedure: A newer surgical approach that combines draining the pancreatic duct with removal of some pancreatic tissue Total pancreatectomy with islet autotransplantation (TPIAT): A complex surgery involving removing the entire pancreas and transplanting insulin-producing pancreatic islet cells into the liverPreventionThere is no guaranteed way to prevent chronic pancreatitis, but certain lifestyle habits may lower your risk of the condition or slow the progression of the disease and reduce symptom flare-ups. These lifestyle habits include the following: Manage your weight: Extra body weight can impair pancreatic function and increase the risk of gallstones and diabetes. Maintaining the body weight that you and your healthcare provider discussed can help lower your chances of developing chronic pancreatitis or complications of the condition. Avoid excessive alcohol consumption: Heavy alcohol consumption is a leading cause of chronic pancreatitis. Abstaining from alcohol or drinking in moderation can lower your risk.Quit smoking: Smoking can worsen inflammation and contribute to the development or worsening of chronic pancreatitis. Follow a low-fat diet: A low-fat diet and small, frequent meals throughout the day may help prevent symptom flare-ups.Related Conditions Chronic pancreatitis can increase your risk of developing other health problems, including:Diabetes: Chronic inflammation can damage insulin-producing cells in the pancreas, leading to difficulty regulating blood sugar levels.Malnutrition: Digestive problems associated with chronic pancreatitis can make it difficult for your body to absorb fat and fat-soluble vitamins from food, including vitamins A, D, E, and K. Pancreatic cancer: Chronic pancreatitis increases the risk of developing pancreatic cancer.Living With Chronic Pancreatitis Chronic pancreatitis is a painful, sometimes debilitating condition that can affect your quality of life. While there is no cure, proper management can help you lead a full and active life. The best way to live well with chronic pancreatitis is to follow your treatment plan and adopt healthful lifestyle habits, including avoiding alcohol, avoiding smoking, and eating a low-fat, nutritious diet. Talk to your healthcare provider if you have chronic pancreatitis, your pain is not well-controlled, and your symptoms are worsening. They may recommend adjusting your treatment plan to help manage pain, prevent complications, and improve your quality of life. Frequently Asked Questions

How long can a person with chronic pancreatitis live?

The life expectancy of a person with chronic pancreatitis varies widely based on factors such as disease severity and progression, treatment adherence, and lifestyle habits. Research shows that people with chronic pancreatitis can live for many years following diagnosis, but the condition can reduce overall life expectancy, especially in people who continue smoking or drinking.

What are the four stages of chronic pancreatitis?

The Cambridge classification system assesses the severity of chronic pancreatitis based on changes in the main pancreatic duct and side branches. The four grades include:Grade 1 (equivocal): Normal pancreatic duct, but up to three abnormal side branchesGrade 2 (mild): Normal pancreatic duct with more than three abnormal side branchesGrade 3 (moderate): Abnormal pancreatic duct with dilatation or irregularities and more than three abnormal side branchesGrade 4 (severe): Severely abnormal pancreatic duct with severe blockages, defects, dilated ducts, and abnormal side branches

How fast does chronic pancreatitis progress?

The progression of chronic pancreatitis varies from person to person and depends on factors such as the underlying cause, lifestyle habits, and the effectiveness of treatment. Some people may experience a slow progression over many years, while others may see a more rapid progression, especially if they continue drinking alcohol and smoking.

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