Chronic Pancreatitis

What is chronic pancreatitis?

Your pancreas is a hardworking organ. It makes enzymes that help you digest food. It also makes insulin to keep your blood sugar levels under control.

Acute pancreatitis is a sudden inflammation of your pancreas. This can be very painful. You may experience nausea, vomiting, and fever. If your acute pancreatitis doesn’t get better and slowly gets worse, you 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 gradually destroy your pancreas.

The most common cause of chronic pancreatitis is drinking too much alcohol over many years. 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, a hereditary disease
• 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 episodic and include:

• Abdominal pain in the upper belly that spreads into the back
• Abdominal pain that gets worse when you eat or drink alcohol
• Diarrhea or oily stools
• Nausea and vomiting
• Severe abdominal pain that may be constant or that comes back
• Weight loss

Chronic pancreatitis destroys your pancreas. This means that your body’s ability to make needed enzymes and hormones decreases. This can result in malnutrition, from being unable to digest foods. Chronic pancreatitis can also cause diabetes. This happens from being unable to produce insulin, which controls 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. He or she will also ask you about your drinking history and any family history of pancreatic disease or cystic fibrosis. Blood tests and imaging studies 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 indicate blockage or damage of your gallbladder.
• CT scan. This test creates a 3D 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 telescope inserted through your mouth and into your stomach and upper intestine. An ultrasound attachment on the scope makes images of the pancreas and gallbladder ducts.
• Magnetic resonance cholangiopancreatography. This test uses images made with radio waves, a strong magnet, and a computer. In some MRI tests, you will have dye injected. The dye shows your pancreas and the ducts of your gallbladder.

How is chronic pancreatitis treated?

Day-to-day treatment includes the following: 

• Pain medicine
• Taking pancreatic enzyme supplements with every meal
• Taking insulin, if you develop diabetes

For acute pancreatitis or a flare-up, treatment often requires a hospital stay. 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:

• Being fed through a tube inserted through the nose into the stomach
• Fasting
• Getting IV fluids
• Receiving pain medicines

What are the complications of chronic pancreatitis?

Chronic pancreatitis damages the insulin-producing cells of the pancreas, which may cause these complications: 

• Calcification of the pancreas, which means the pancreatic tissue hardens from deposits of insoluble calcium salts
• Chronic pain
• Diabetes
• Gallstones
• Kidney failure
• Pseudocysts (build up of fluid and tissue debris)
• Pancreatic cancer
• Recurrent acute flare-ups

How can I prevent chronic pancreatitis?

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

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.
• Avoid caffeine.
• Stick to a healthy diet that’s low in fat and protein.
• Eat smaller and more frequent meals.

When should I call my health care provider?

When you start to have acute symptoms, including severe pain that can’t be managed at home. 

Key points

 

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.