Chronic pancreatitis: Treatments, symptoms, and causes

Chronic pancreatitis is a long-term progressive inflammatory disease of the pancreas that leads to permanent breakdown of the structure and function of the pancreas.

The pancreas is a gland organ that is located in the abdomen, behind the stomach and below the ribcage. It specializes in producing important enzymes and hormones that help break down and digest foods. It also makes insulin to moderate the levels of sugar in the blood.

The most common cause is long-term alcohol abuse – it is thought to account for between 70 and 80 percent of all cases.

Chronic pancreatitis results in over 122,000 visits to a doctor and 56,000 hospitalizations annually in the United States.

Significantly more men than women are affected.

Treatment

Location of the pancreas
The pancreas produces important enzymes and hormones that help break down foods.

The following treatments are commonly recommended for chronic pancreatitis.

Lifestyle changes

People with chronic pancreatitis will need to undergo some lifestyle changes. These will include:

Stopping alcohol consumption: Giving up drinking will help prevent further damage to the pancreas. It will also contribute significantly towards relieving the pain. Some people may need professional help to quit alcohol.

Stopping tobacco use: Smoking is not a cause of pancreatitis, but it can accelerate the progression of the disease.

Pain management

Treatment should not only focus on helping ease the pain symptoms, but also depression which is a common consequence of long-term pain.

Doctors will usually use a step-by-step approach, in which mild painkillers are prescribed, gradually becoming stronger until pain becomes manageable.

Insulin

The pancreas may stop producing insulin if the damage is extensive. The individual is likely to have developed diabetes type 1.

Regular insulin treatment will become part of the treatment for the rest of the person’s life. Diabetes type 1 caused by chronic pancreatitis involves injections, not tablets, because most likely the digestive system will not be able to break them down.

Surgery

Severe chronic pain sometimes does not respond to painkilling medications. The ducts in the pancreas may have become blocked, causing an accumulation of digestive juices which puts pressure on them, causing intense pain. Another cause of chronic and intense pain could be inflammation of the head of the pancreas.

Several forms of surgery may be recommended to treat more severe cases.

Endoscopic surgery

A narrow, hollow, flexible tube called an endoscope is inserted into the digestive system, guided by ultrasound. A device with a tiny, deflated balloon at the end is threaded through the endoscope. When it reaches the duct, the balloon is inflated, thus widening the duct. A stent is placed to stop the duct from narrowing back.

Pancreas resection

The head of the pancreas is surgically removed. This not only relieves the pain caused by inflammation irritating the nerve endings, but it also reduces pressure on the ducts. Three main techniques are used for pancreas resection:

The Beger procedure: This involves resection of the inflamed pancreatic head with careful sparing of the duodenum, the rest of the pancreas is reconnected to the intestines.

The Frey procedure: This is used when the doctor believes pain is being caused by both inflammation of the head of the pancreas as well as the blocked ducts. The Frey procedure adds a longitudinal duct decompression to the pancreatic head resection – the head of the pancreas is surgically removed, and the ducts are decompressed by connecting them directly to the intestines.

Pylorus-sparing pancreaticoduodenectomy (PPPD): The gallbladder, ducts, and the head of the pancreas are all surgically removed. This is only done in very severe cases of intense chronic pain where the head of the pancreas is inflamed, and the ducts are also blocked. This is the most effective procedure for reducing pain and conserving pancreas function. However, it has the highest risk of infection and internal bleeding.

Total pancreatectomy

This involves the surgical removal of the whole pancreas. It is very effective in dealing with the pain. However, a person who has had a total pancreatectomy will be dependent on treatment for some of the vital functions of the pancreas, such as the release of insulin.

Autologous pancreatic islet cell transplantation (APICT)

During the total pancreatectomy procedure, a suspension of isolated islet cells is created from the surgically removed pancreas and injected into the portal vein of the liver. The islets cells will function as a free graft in the liver and will produce insulin.

Diet

Taking dietary measures to reduce the effects of pancreatitis are vital.

The pancreas is involved in digestion, but pancreatitis can impair this function. This means that people with the disease will have difficulty digesting many foods.

Rather than three large meals a day, people with pancreatitis will be advised instead to consume six small meals. It is also better to follow a low-fat diet.

Managing the diet during pancreatitis aims to achieve four outcomes:

reducing the risk of malnutrition and shortages of certain nutrients

avoiding high or low blood sugar

managing or preventing diabetes, kidney disease, and other complications

decreasing the likelihood of an acute flare-up of pancreatitis

A diet plan will either be drawn up by the doctor, or the patient may be referred to a qualified dietitian. The plan is based on the current levels of nutrients in the blood shown in diagnostic testing.

Meal plans will generally involve food sources that are high in protein and have dense nutritional content. These are likely to include whole grains, vegetables, fruits, low-fat dairy products, and lean protein sources, such as boneless chicken and fish.

Fatty, oily, or greasy foods should be avoided, as these can trigger the pancreas to release more enzymes than usual. As a primary cause of chronic pancreatitis, alcohol is also best avoided while on a pancreatitis-friendly diet.

Depending on the extent of the damage, patients may also have to take artificial versions of some enzymes to aid digestion. These will ease bloating, make their feces less greasy and foul-smelling, and help any abdominal cramps.

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