Chronic pancreatitis

Chronic pancreatitis is a long-standing inflammation of the pancreas that alters its normal structure and functions. It can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption.

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Video on Chronic Pancreatitis

• Video on Chronic Pancreatitis

Symptoms

Patients with chronic pancreatitis can present with persistent abdominal pain or steatorrhea (diarrhea resulting from malabsorption of the fats in food, typically very bad-smelling and equally hard on the patient), as well as severe nausea. Some patients with chronic pancreatitis often look very sick, while others don't appear to be unhealthy at all.

Considerable weight loss, due to malabsorption, is evident in a high percentage of patients, and can continue to be a health problem as the condition progresses. The patient may also complain about pain related to their food intake, especially those meals containing a high percentage of fats and protein.

Causes

The most common cause in the Western world of chronic pancreatitis is excess alcohol ingestion.^{[citation needed]} Gallstone-associated pancreatitis is predominantly acute or relapsing-acute in nature, and some cases of chronic pancreatitis are of undetermined or idiopathic origin. A few are inherited or autoimmune in nature or secondary to Sphincter of Oddi Dysfunction (SOD). Other less frequent causes include chronic steroid and or anti-inflammitory use. In up to one quarter of cases, no cause can be found.

Cystic fibrosis is the most common cause of chronic pancreatitis in children. In other parts of the world, severe protein-energy malnutrition is a common cause.

Diagnosis

Serum amylase and lipase may well not be elevated in cases of advanced chronic pancreatitis, but are often used as markers for detecting pancreatic inflammation in undiagnosed patients. Common tests used to determine chronic pancreatitis are serum amylase and serum lipase blood tests, triglyceride blood tests, enzyme measurement in stool, X-rays, ultrasounds, EUS, CT scans, MRI's and MRCP's. A more invasive test called an ERCP (endoscopic retrograde cholangiopancreatography), is considered the gold standard procedure for diagnosing chronic pancreatitis. Pancreatic calcification can often be seen on X-rays, as well as CT scans.

Treatment

The different treatment modalities for management of chronic pancreatitis are medical measures, therapeutic endoscopy and surgery.^[1] Treatment is directed, when possible, to the underlying cause, and to relief of the pain and malabsorption. Diabetes may occur and need long term insulin therapy. (Type 3 diabetes)

The abdominal pain can be very severe and require high doses of analgesics. Disability and mood problems are common, although early diagnosis and support can make these problems manageable.

Pancreatic Enzyme Supplementation

Replacement pancreatic enzymes are often effective in treating the malabsorption and steatorrhea. However, the outcome from 6 randomized trials has been inconclusive regarding pain reduction.^[2]

Surgery

Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.^[3]

Therapeutic Endoscopy

Endoscopic drainage of the pancreatic duct is less successful than surgical drainage and does not shorten the hospital stay.^[4][5]

References

1. ^ American Gastroenterological Association Medical Position Statement (1998). "American Gastroenterological Association Medical Position Statement: treatment of pain in chronic pancreatitis". Gastroenterology 115 (3): 763-4. PMID 9721174.
2. ^ Warshaw AL, Banks PA, Fernández-Del Castillo C (1998). "AGA technical review: treatment of pain in chronic pancreatitis". Gastroenterology 115 (3): 765-76. PMID 9721175.
3. ^ Society for Surgery of the Alimentary Tract (SSAT) (2004). Operative treatment for chronic pancreatitis.. Retrieved on 2007-06-09.
4. ^ Cahen DL, Gouma DJ, Nio Y, et al (2007). "Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis". N. Engl. J. Med. 356 (7): 676-84. doi:10.1056/NEJMoa060610. PMID 17301298.
5. ^ Díte P, Ruzicka M, Zboril V, Novotný I (2003). "A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis". Endoscopy 35 (7): 553-8. doi:10.1055/s-2003-40237. PMID 12822088.

See also

• Acute pancreatitis
• Exocrine pancreatic insufficiency

• Medical Information and Treatment of Chronic Pancreatitis