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

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

The most common cause of chronic pancreatitis is long-term alcohol use disorder, which causes 40–70% of all cases. Autoimmune conditions, blockages of the ducts, vitamin deficiencies, chemotherapy, and some other factors may also cause chronic pancreatitis.

Chronic pancreatitis sometimes begins with acute pancreatitis, which is a sudden and severe type of the condition. It can persist after the acute phase passes, causing progressive and permanent damage to the pancreas.

Keep reading to learn more about chronic pancreatitis, including treatment, symptoms, and causes.

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Common signs and symptoms of chronic pancreatitis include severe upper abdominal pain that can sometimes travel along the back and is more intense following a meal, as well as nausea and vomiting, more commonly occurring during episodes of pain.

As the condition progresses, the episodes of pain become more frequent and severe. Some individuals will experience constant abdominal pain.

As chronic pancreatitis progresses, and the ability of the pancreas to produce digestive juices deteriorates, the following symptoms may appear:

  • smelly, greasy stools
  • bloating
  • abdominal cramps
  • flatulence

Eventually, the pancreas may not be able to produce insulin at all, leading to type 1 diabetes, which can produce the following symptoms:

  • thirst
  • frequent urination
  • intense hunger
  • unintentional weight loss
  • tiredness
  • blurred vision

Treatment focuses on alleviating symptoms, slowing or stopping damage to the pancreas, and managing health problems stemming from chronic pancreatitis.

Lifestyle changes

People with chronic pancreatitis may need to make some lifestyle changes, including:

  • Avoiding alcohol consumption, if applicable: Stopping consuming alcohol will help prevent further damage to the pancreas. It will also help relieve the pain. Some people may need professional help to give up alcohol. Continuing to drink increases the risk of death.
  • Stopping tobacco use, if applicable: Smoking is not a cause of pancreatitis, but it can accelerate the progression of the disease.
  • Making dietary changes: Eating small low fat meals more frequently may help ease symptoms.
  • Taking vitamins and enzymes: A person may need to replace pancreatic enzymes in their diet or take fat-soluble vitamins to ensure proper nourishment.

Pain management

Doctors may recommend pain relievers, starting with over-the-counter options. If these do not work, a doctor may recommend stronger pain-relieving medication, including:

  • nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen
  • pregabalin
  • opioids, if other pain treatments prove ineffective

Living in pain can lead to depression, which may increase the perception of pain. A doctor may prescribe antidepressants to ease both emotional and physical pain.

Insulin

The pancreas may stop producing insulin if the damage is extensive. This can cause diabetes. In one study involving people with genetic pancreatitis, 48% of the participants eventually developed diabetes.

A person may need regular insulin therapy if the pancreas no longer produces this hormone.

Surgery

Sometimes, severe chronic pain does not respond to pain relievers. The ducts in the pancreas may have a blockage. This can cause an accumulation of digestive juices, causing intense pain.

Another cause of chronic intense pain could be inflammation of the head of the pancreas.

Several forms of surgery may treat more severe cases.

Endoscopic surgery

A surgeon inserts a narrow, hollow, flexible tube called an endoscope into the digestive system, guided by ultrasound. This allows them to thread a tiny deflated balloon through the endoscope and into the duct. Inflating the balloon widens the duct so that the surgeon can place a stent to keep it open.

Surgery relieves symptoms in approximately 60% of people who choose this option.

Pancreas resection

Pancreas resection is the removal of part of the pancreas. This relieves the pain caused by inflammation irritating the nerve endings, and 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. Then, a surgeon attaches the rest of the pancreas to the intestines.
  • The Frey procedure: A doctor may recommend this when inflammation at the head of the pancreas and blocked ducts together cause pain. The Frey procedure adds a longitudinal duct decompression to the pancreatic head resection. The surgeon removes the head of the pancreas and compresses the ducts by connecting them to the intestines.
  • Pylorus-sparing pancreaticoduodenectomy: A surgeon removes the gallbladder, the ducts, and the head of the pancreas. Doctors typically only recommend this in very severe cases of intense chronic pain when 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.

While treatment can work well, it is also very risky, with a death rate as high as 10%.

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

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 islet cells will function as a free graft in the liver and produce insulin.

Alternative and complementary remedies will not cure chronic pancreatitis, but they may help ease symptoms.

Combining alternative remedies with standard treatments may help get better results. Replacing standard treatments with alternative ones may allow the disease to progress more rapidly, causing more symptoms.

Some options include:

  • Yoga: Yoga may help a person relax, easing pain, anxiety, and depression.
  • Massage: Massage can improve circulation and may help with relaxation and pain.
  • Acupuncture: Acupuncture is a traditional Chinese medicine technique for realigning the body’s energy. Some people anecdotally report that it helps them.
  • Meditation: Meditation can help ease the stress of living with a chronic condition and may help some individuals better manage their pain.
  • Exercise: Exercise can help a person reach or maintain a moderate body weight and may reduce the side effects of other conditions, potentially also reducing inflammation. Moreover, regular exercise may improve mood and alleviate pain.

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

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

Rather than three large meals per 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 be drawn up by a doctor, or the person may be referred to a qualified dietitian. The plan is based on the person’s 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, individuals 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.

Chronic pancreatitis is usually a complication of recurrent episodes of acute pancreatitis. These can lead to permanent damage in the pancreas.

Acute pancreatitis occurs when trypsin becomes activated within the pancreas. Trypsin is an enzyme that is produced in the pancreas and released into the intestines, where it breaks down proteins as part of digestion.

Trypsin is inactive until it has reached the intestines. If trypsin becomes activated inside the pancreas, it will start to digest the pancreas itself, leading to irritation and inflammation of the pancreas. This becomes acute pancreatitis.

Alcohol misuse

Consuming alcohol can cause a process that triggers the activation of trypsin inside the pancreas, as can gallstones.

People who misuse alcohol and develop acute pancreatitis tend to have repeated episodes and eventually develop chronic pancreatitis.

Repeated bouts of acute pancreatitis eventually cause permanent damage to the pancreas, leading to chronic pancreatitis.

This is also known as alcohol-related chronic pancreatitis.

Idiopathic chronic pancreatitis

When a condition is idiopathic, it has no known cause. Idiopathic chronic pancreatitis accounts for most of the remaining cases.

Most cases of idiopathic chronic pancreatitis develop in people aged 10–20 years and those aged over 50 years.

Experts do not exactly know why other age groups are rarely affected. The SPINK-1 and the CFTR genes, types of mutated genes, exist in about 50% of people with idiopathic chronic pancreatitis. These genetic mutations may undermine the functions of the pancreas.

Other, much rarer causes include:

  • autoimmune chronic pancreatitis, wherein the person’s immune system attacks the pancreas
  • hereditary pancreatitis, wherein a person has a genetic condition and is born with a pancreas that is not working effectively
  • cystic fibrosis, another genetic condition that damages various organs, including the pancreas

While chronic pancreatitis can develop in anyone, certain factors increase the risk, including:

  • chronic alcohol misuse
  • autoimmune conditions
  • chronic inflammation, often due to an autoimmune condition
  • chemotherapy
  • genetic mutations that may run in families
  • nutritional deficiencies

There are no reliable tests to diagnose chronic pancreatitis. A doctor may suspect the condition because of the person’s symptoms, history of repeated acute pancreatitis flare-ups, or alcohol misuse.

Blood tests may be useful in checking the blood glucose levels, which may be elevated.

Blood tests for elevated levels of amylase and lipase are not reliable at this stage. Amylase and lipase blood levels rise during the first couple of days of pancreatitis and then settle back to normal after 5–7 days. An individual with chronic pancreatitis would have had the condition for much longer.

Doctors need to have a good look at the pancreas in order to diagnose the condition properly. This will most likely involve:

  • An ultrasound scan: High frequency sound waves create an image of the pancreas and its surroundings on a monitor.
  • A CT scan: X-rays are used to take many pictures of the same area from several angles, which are then placed together to produce a 3D image. The scan will reveal changes of chronic pancreatitis.
  • Magnetic resonance cholangiopancreatography scan: This scan shows the bile and pancreatic ducts more clearly than a CT scan.
  • An endoscopic ultrasound: An endoscope is inserted into the digestive system. The doctor uses ultrasound to guide the endoscope through.

People with chronic pancreatitis have a greater risk of developing pancreatic cancer. If symptoms worsen, especially the narrowing of the pancreatic duct, doctors may suspect cancer. If so, they will order a CT scan, an MRI scan, or an endoscopic study.

There are several ways in which chronic pancreatitis can develop and become more harmful to a person’s well-being.

Stress, anxiety, and depression

The condition may have an effect on a person’s psychological and emotional well-being. Constant or recurring pain that is often severe may cause distress, anxiety, irritability, stress, and depression.

It is important for a person to tell a doctor if they feel depressed, anxious, or very unhappy. A support group can help them learn coping skills and feel less isolated.

Pseudocyst

This is a collection of tissue, fluid, debris, pancreatic enzymes, and blood in the abdomen, caused by leakage of digestive fluids escaping from a pancreatic duct that is not working effectively.

Pseudocysts do not usually cause any health problems. However, sometimes they can become infected, cause blockage to part of the intestine, or rupture and cause internal bleeding. If this happens, the cyst will have to be surgically drained.

Pancreatic cancer

Pancreatic cancer is more common in people with chronic pancreatitis. Although the relative risk increases, the absolute risk remains low.

Avoiding alcohol consumption significantly reduces the risk of developing chronic pancreatitis in people with acute pancreatitis. This is especially the case for individuals who drink large amounts of alcohol regularly.

Refraining from drinking excessive amounts of alcohol may prevent pancreatitis. It is also important to manage chronic medical conditions to reduce the risk of inflammation, which damages the pancreas.

Chronic pancreatitis is a serious condition that can undermine a person’s overall health and shorten their life span. It can lead to pancreatic cancer, diabetes, and other chronic conditions.

Several medical conditions increase the risk of pancreatitis. This means many people with this diagnosis also have other serious health issues.

Early diagnosis and treatment are critical for prolonging a person’s life and easing their pain. The right treatment can slow or stop damage to the pancreas.

Individuals with abdominal pain or other pancreatitis symptoms should contact a doctor to discuss treatment options.