Chronic Pancreatitis: Symptoms, Causes, and Diagnosis
While the pain of pancreatitis often subsides on its own, chronic pancreatitis can be a severe, life-threatening illness.
Pancreatitis, an inflammation of the pancreas, comes in two forms: acute and chronic.
Acute pancreatitis is the most common form of the condition and often subsides after a few days with treatment.
Chronic pancreatitis, on the other hand, is a lasting illness that can cause serious and life-threatening problems.
The worldwide prevalence of chronic pancreatitis is about 50 per 100,000 people, according to a report published in July 2013 in the journal Gastroenterology. (1)
It affects men more than women, and is most common in middle-aged people.
What Are the Causes of Chronic Pancreatitis?
The pancreas, which is located in the upper left area of the abdomen, has two main functions: It produces digestive enzymes that are sent to the small intestine to aid in food digestion, and it excretes insulin, glucagon, and other hormones that help regulate blood-sugar levels.
Pancreatitis (both acute and chronic) arises when the digestive enzymes activate while in the pancreas and begin digesting pancreatic tissue, leading to an inflammatory response.
Long-term, heavy alcohol consumption is the most common cause of chronic pancreatitis. Some estimates suggest chronic alcohol use accounts for up to 70 percent of chronic pancreatitis cases in adults, according to a report in American Family Physician. (2)
Other potential causes and risk factors of chronic pancreatitis are outlined in this TIGAR-O classification system mnemonic:
- Idiopathic (unknown causes)
- Recurrent and severe acute pancreatitis
Toxic-metabolic causes and risk factors of chronic pancreatitis include:
- Tobacco (smoking is a risk factor for chronic pancreatitis)
- Chronic kidney failure
- Hyperlipidemia and hypertriglyceridemia (elevated levels of lipids or fat in the blood)
- Hypercalcemia (elevated blood calcium levels)
- Various types of medication, such as statins, steroids, valproic acid, oral contraceptives, and interferon
Genetic causes of chronic pancreatitis are related to mutations to several genes. They include:
- PRSS1 (hereditary pancreatitis)
- CFTR (present in those with cystic fibrosis)
- SPINK1 (3)
Autoimmune causes of chronic pancreatitis are associated with autoimmune diseases, such as:
Obstructive causes of chronic pancreatitis include conditions that block the pancreatic duct, such as tumors; divisum, a birth defect in which a pancreatic duct doesn't form; and disorders involving the sphincter of Oddi, a muscle that controls the flow of digestive juices through ducts from the liver and pancreas into the small intestine.
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What Are the Symptoms of Chronic Pancreatitis?
The most common symptom of chronic pancreatitis is upper abdominal pain. In fact, pain is the overriding symptom for 85 to 90 percent of people with chronic pancreatitis, according to a report published in The Lancet. (4)
This pain can be constant or occur in weeklong episodes, and is often associated with nausea and vomiting. For many people, it spreads to the back and worsens after eating or drinking, potentially causing them to fear eating and drinking, which results in weight loss.
Pain can be partially eased by sitting up and leaning forward, or by applying heat packs to the spine or upper abdomen. Generally, the pain subsides as the pancreatitis worsens, possibly because the pancreas has stopped making the destructive digestive enzymes.
Other symptoms of chronic pancreatitis can include:
- Chronic weight loss unrelated to changes in eating habits
- Oily stools
- Clay-colored stools
Chronic pancreatitis may lead to complications, such as:
How Is Chronic Pancreatitis Diagnosed?
Chronic pancreatitis is easily misdiagnosed as acute pancreatitis because their symptoms are similar. But there are a number of tests to help diagnose chronic pancreatitis, including:
There are also tests to diagnose specific causes of chronic pancreatitis. For instance, serum IgG4 tests look for an antibody associated with autoimmune pancreatitis.
Treatment goals for chronic pancreatitis include relieving pain, preventing recurring symptoms, managing complications such as diabetes and malnutrition, and helping with digestion.
Treatments for chronic pancreatitis can include:
- Abstinence from alcohol and smoking
- Pain medication, including opioids if pain is severe
- Steroids for rapid symptomatic relief in autoimmune pancreatitis
- Dietary changes, including limiting fats, eating smaller (but more frequent) meals, and limiting caffeine
- Insulin for diabetes treatment
- Pancreatic enzyme supplements to help with digestion (very common when there is chronic diarrhea or oily stools)
- Surgery to remove blockages or drain pseudocysts
Doctors sometimes prescribe antioxidant therapy to relieve pain from chronic pancreatitis, but it's unclear if this treatment is effective.
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What Is a Pancreatic Diet?
While there is no one specific, standard diet recommended for those with chronic pancreatitis, doctors have laid out some general rules for nutrition.
If you have chronic pancreatitis, alcohol and high-fat foods should be avoided because of their potential to tax an already overworked pancreas.
You can reduce your risk of getting pancreatitis in the first place by eating a low-fat, healthy diet. According to the National Institute of Diabetes and Digestive and Kidney Diseases, regularly eating foods high in fat can lead to high levels of fat in your blood. (5)
The National Institutes of Health says that pancreatitis patients should consume no more than 30 grams of fat a day. (6) Eating four to six small meals a day is also recommended in order to avoid straining your digestive system.
Because chronic pancreatitis makes it difficult for the body to absorb nutrients, your doctor will work with you to prevent malnutrition. Vitamin deficiencies that result from chronic pancreatitis can lead to osteoporosis and other issues, so you'll be regularly tested, and your doctor might prescribe you multivitamins and other supplements.
Keeping hydrated is also important. Dehydration can cause a flare-up, says the National Pancreas Foundation, so make sure to keep a bottle of water on you at all times. (7)
If you're experiencing a flare-up, your doctor may advise you to fast for a few days to give the pancreas a chance to rest, or to follow a clear liquid diet.
Video: Treatment of Chronic Pancreatitis - Mark Topazian, M.D.
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