Chronic Pancreatitis

Chronic Pancreatitis Overview

In addition to regulating the glucose in your blood, the pancreas produces enzymes for food digestion.

However, with chronic inflammation, these enzymes can become activated within the pancreas, leading to recurrent damage and scar tissue formation. The ducts that direct these enzymes out of your pancreas can also become blocked with scar tissue or stones, worsening the condition and your pain.

Symptoms

You may experience pain from the condition. Pain resides in your upper abdomen and upper back. It can come and go or last a long time. It can also worsen when you eat or drink.

Pancreatitis also causes digestive symptoms like diarrhea, oily stool, nausea, bloating, weight loss and dehydration. As chronic pancreatitis progresses you may develop diabetes and vitamin deficiencies.

Causes

A variety of conditions can cause chronic pancreatitis, such as:

• Alcohol abuse
• Chronic smoking
• Severe acute pancreatitis
• Repeated attacks of acute pancreatitis from gallstones, elevated triglycerides, medications or elevated calcium levels
• Genetic mutations
• Autoimmune disease
• Congenital abnormalities of the pancreatic or bile ducts

Diagnosis

Your IU Health physician may pursue the diagnosis by clinical history and examination, laboratory evaluation and by identifying pancreatic abnormalities on imaging procedures such as:

• CT scan
• Magnetic resonance imaging (MRI)
• Cholangiopancreatography (MRCP)

Diagnosing and treating pancreatitis may require an endoscopic procedure where your physician guides a long, flexible tube with a camera on the end down into your stomach and other digestive organs to check for and treat abnormalities in your pancreas.

Endoscopic Ultrasound (EUS)

Endoscopic ultrasound (EUS) uses sound waves to generate pictures of your pancreas and surrounding internal organs to diagnose and determine the extent of the disease. Your physician can also use it to direct a thin needle to either sample a concerning abnormality in your pancreas or inject a numbing substance to control your pain.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP also helps identify abnormalities inside your pancreas by combining X-rays and endoscopy. Complications of chronic pancreatitis, such as pancreas duct strictures or pancreas duct stones can be treated at the time of ERCP. Learn more about ERCP.

Treatment

Our gastroenterologists collaborate with our expert pain specialists to give you comprehensive relief. They may suggest:

• Hospitalization to manage your pain
• Special nutrition guidelines to allow the pancreas to rest and heal
• A liquid diet for days or weeks, with slow reintroduction of solid foods under close supervision
• Nutritional supplements through a specialized feeding tube or IV for days or weeks

Lifestyle changes, such as avoiding alcohol, avoiding smoking and eating a healthy diet, help decrease your risk for pancreatitis in addition to one or more of the following:

• Pain medicines. Narcotic pain medicines can pose risks so your physicians may administer non-narcotic prescription pain medicines to alleviate or stop your pain. You should take them exactly as your physician instructs to avoid side effects.
• Pancreatic enzyme replacement therapy and nutrition support counseling. Pancreatic enzyme replacement therapy promotes proper absorption of nutrients and relieves pain. Your registered dietician can help you as well.
• Endoscopic Retrograde Cholangiopancreatography (ERCP). ERCP can remove the stones and treat scar tissue.
• Extracorporeal Shock Wave Lithotripsy (ESWL). Uses high frequency sound waves to break up stones that block the ducts of the pancreas. With ERCP, it is now one of the most effective ways to treat pancreatic duct stones found in chronic pancreatitis.
• Intrathecal pain pumps. Pain pumps deliver pain medicines directly into your spinal fluid at scheduled times, creating seamless pain relief.
• Nerve blocks. Nerve blocks consist of anesthetic and steroids in an injection to the nerve affected by pancreatitis pain.
• Surgery. Damage to your pancreas from chronic pancreatitis may require surgery to drain and bypass blockages in the pancreas duct. Removal of part of or the entire pancreatic gland may also help.
• Physical therapy. Physical therapy for massage, stretching, exercise and hot/cold therapy to relax muscles and reduce pain after surgery may help you maintain your flexibility and muscle movements.
• Antidepressants. Conditions that cause chronic pain can also cause depression and anxiety--keeping you from feeling the full effects of your treatments. Our physicians may prescribe antidepressants to restore your quality of life.
• Psychological counseling. Speaking to an expert psychologist or psychiatrist may also help you cope with pain, understand the emotions surrounding your chronic pain and connect you to support groups.