Chronic pancreatitis can cause tummy (abdominal) pain, poor digestion, diabetes and other complications. Alcohol is the common cause. Treatment includes painkillers, other medication and, most importantly, stopping alcohol drinking for good. Surgery is sometimes needed.
The pancreas is in the upper tummy (abdomen) and lies behind the stomach and guts (intestines). It makes a fluid that contains chemicals (enzymes) that are needed to digest food. The enzymes are made in the pancreatic cells and are passed into tiny tubes (ducts). These ducts join together like branches of a tree to form the main pancreatic duct. This drains the enzyme-rich fluid into the part of the gut just after the stomach (the duodenum). The enzymes are in an inactive form in the pancreas (otherwise they would digest the pancreas). They are 'activated' in the duodenum to digest food.
Groups of special cells called 'Islets of Langerhans' are scattered throughout the pancreas. These cells make the hormones insulin and glucagon. The hormones are passed (secreted) directly into the bloodstream to control the blood sugar level.
The bile duct carries bile from the liver and gallbladder. This joins the pancreatic duct just before it opens into the duodenum. Bile passes into the duodenum and helps to digest food.
Pancreatitis means inflammation of the pancreas. There are two types.
Note: gallstones, which are a common cause of acute pancreatitis, do not cause chronic pancreatitis, unless the little tube which attaches the gallbladder to the liver (the bile duct) is damaged by a stone or by infection.
A persistent inflammation develops in the pancreas. The reason why alcohol or other factors trigger this inflammation is not clear, although in some people it is thought to relate to their genes. Over time, the inflammation causes scarring and damage to parts of the pancreas. This can then lead to not enough chemicals (enzymes) and insulin being made. A lack of enzymes causes poor digestion of food (malabsorption). A lack of insulin causes diabetes.
Over time, clumps of calcium are deposited and can form stones in the pancreas. Calcium stones and/or scarring of the pancreatic tubes (ducts) may block the flow of enzymes along the pancreatic ducts.
Chronic pancreatitis often gets worse with time. The time from the initial triggering of inflammation to damage, scarring, calcium stones, and then to developing digestion problems or diabetes is often several years. However, many months or years of this process can go on before any symptoms are first noticed.
The symptoms can vary between cases. The most common symptoms include:
Alcohol-related chronic pancreatitis usually follows a typical pattern. There is often a first bout of acute pancreatitis with severe abdominal pain and vomiting. This may settle but, if drinking continues, the pancreas becomes more and more damaged. Recurring bouts of acute pancreatitis may develop. Unlike a 'one-off' acute pancreatitis, the pain may then not go and ongoing chronic pain and other symptoms may then develop.
Unfortunately, there is currently no single test for chronic pancreatitis.
Diagnosing chronic pancreatitis in its early stages is often difficult. Many pancreatic cells can be damaged before abnormalities show up on tests, X-rays or scans. The amount of enzymes made by the pancreas and the number of insulin-producing cells can become quite low before any symptoms of poor digestion or diabetes develop.
Once the damage and scarring to the pancreas is more severe, or when calcium stones start to form, then the damaged pancreas can be detected by X-rays or scans. However, by this time the malabsorption or diabetes' symptoms may have already developed.
Tests done usually include:
Most people with chronic pancreatitis do not have complications. However, the following may occur:
It is fairly common to feel low when you have chronic pancreatitis, especially if you are in pain. Some people even become depressed, which can respond well to treatment. It is important to talk to your doctor about any symptoms of depression you may have.
If you have autoimmune pancreatitis then you may be given a course of steroid tablets.
Most people with chronic pancreatitis do not need surgery but an operation is sometimes needed. The common reason for surgery is for persistent bad pain that is not helped by painkillers or other methods. Improvement in pain occurs in about 7 in 10 patients who have surgery. The operation usually involves removing part of the pancreas.
There are different techniques that remove different amounts of the pancreas. The one chosen depends on the severity of your condition, whether the tube which leads to the pancreas (the pancreatic duct) is blocked, and also on various other factors.
Other operations may be advised in some cases. For example, removal of a large calcium stone that is blocking the main pancreatic duct. Another procedure that may help in some people is to 'stretch' wide a narrowed pancreatic duct to allow better drainage of pancreatic enzymes.
Surgery may also be needed if a complication develops. For example, if a blocked bile duct or pseudo-cyst develops.
Newer treatments are being introduced. In some cases the pancreas is removed and some of your own cells are transplanted back into the liver. This has been shown to improve both pain and also control of diabetes.
If the pain is persistent you may be offered a procedure to block the nerve supply to the area. Examples of treatments which involve this approach are coeliac plexus block and spinal cord stimulation.
If you need surgery, then your surgeon will be able to discuss with you in detail the type of operation you need.
If alcohol is the cause of chronic pancreatitis then other alcohol-related illnesses commonly also develop. If you continue to drink alcohol and pancreatitis becomes severe than life expectancy is typically reduced by 10-20 years. This is due to complications of pancreatitis or to other alcohol-related illnesses. If you stop drinking alcohol completely in the early stages of the condition then the outlook is better.
The outlook for other less common causes of chronic pancreatitis depends on the cause and severity of the condition.