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.