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CORE Charity: Chronic Pancreatitis

Raising awareness and funding research into gut and liver disease

CONTENTS

It is vital for doctors to do research. If you treat disease you have to have an idea of how they work. With research you see things from a different perspective
Dr. Piyara Begum

Chronic Pancreatitis

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Chronic Pancreatitis
The pancreas is part of the digestive system. It lies in the upper half of the abdomen behind the stomach and in front of the spine. It is a solid flat gland about nine inches long, salmon pink in colour and shaped like a comma. It has an important role in hormonal production, such as insulin and also a digestive function helping to assist the absorption of nutrients.[1] 
 
What is chronic pancreatitis?
Chronic pancreatitis is the result of damage to the pancreas, such as inflammation of the pancreas, which causes scarring, fibrosis, or the development of calcium deposits in the gland.[2] The scarring can result in reducing insulin production from the pancreas and a reduction in enzyme production, which can lead to failure to absorb fats or proteins.
The scarring can cause different problems in different people. In some people, nerves can get irritated, causing pain. In others, the scarring can result in acute attacks of inflammation. In other people, the scarring can produce a lump in the pancreas, which can cause narrowing of the end of the tube between the liver and the bowel (the bile duct). This can result in jaundice [3]. In other patients, the inflammation can produce cysts on the pancreas (pseudocysts). Sometimes, scarring can cause a narrowing in the drainage tube from the pancreas (the pancreatic duct – stricture). Insulin production can also be affected, causing diabetes.
 
What causes chronic pancreatitis?
There are many causes of chronic pancreatitis but in the UK, most are associated with increased alcohol intake. Alcohol is toxic to the pancreas and some people are more susceptible to damage from alcohol than others. Other causes include follow-on of damage from acute pancreatitis, where some patients develop chronic pancreatitis because of an inherited tendency related to trypsinogen and inhibitory protein defects.
Other causes include cystic fibrosis, trauma and auto-immune problems; in some people who develop chronic pancreatitis, the cause is not understood.[4]
 
What symptoms do you get?
Chronic pancreatitis causes two main problems;
 Chronic pain; usually felt in the upper abdomen and back and can vary from mild to very severe and unremitting.felt in the upper abdomen and back
 Weight loss
 Diarrhoea can occasionally occur
 Pancreatic insufficiency,which results in a reduced ability of the pancreas to produce insulin and the enzymes that help to digest fats [5]. There are a number of other problems:
• Reduction in insulin production, which can lead to diabetes.
• Reduction in enzyme secretion causing fat malabsorption. This causes stools to become pale, bulky and frequently difficult to flush away. 
• Recurrent flare-ups of acute inflammation, with sudden onset of upper abdominal pain, vomiting and inflammation.
• Cyst formation. Sometimes, damage to the pancreas can produce cysts on the pancreas (pseudocysts).
• Blockage of the bile duct causing jaundice.
• Blockage of the duodenum causing vomiting.
 
How is it diagnosed?
The diagnosis of chronic pancreatitis is based on typical clinical features such as weight loss (from fat malabsorption) and characteristic upper abdominal and back pain. Sometimes, these are not present and people can present with recurrent attacks of acute inflammation.
The diagnosis is usually confirmed with tests. These can include imaging such as ultrasound and CT scans. CT scans can reveal various features such as calcification within the pancreas, a lump in the pancreas, dilatation of the pancreatic duct or cyst formation [6].
Other tests can be helpful to confirm the diagnosis and look more closely into the effects of chronic pancreatitis. These tests include endoscopic ultrasound scanning or magnetic resonance scanning of the pancreas, which can look for narrowing in the pancreatic duct [6].
There are also tests that can measure the amount of fat that is not being absorbed in the gut.
 
 
 
How can chronic pancreatitis be treated? [7]
The treatment of chronic pancreatitis depends on the problems caused by chronic pancreatitis and this can be different in different patients.
Treatment is directed whenever possible to correct the underlying cause; to relieve pain, correct fat malabsorption or reverse weight loss. Diabetes may occur and will need treatment with drugs or insulin.
The abdominal pain can be quite severe and require treatment with either simple painkillers or sometimes opiates.
To reverse the fat malabsorption, replacement pancreatic enzyme capsules are available.
 
Endoscopic Procedures
An endoscope can be used to widen areas of narrowing in the pancreas or to remove stones, which can, in a few patients, result in symptom improvement.
 
Surgery [8]
Surgery is available in specialised centres for some suitable patients. Two types of operation are commonly employed. These involve removing the most affected part of the pancreas or draining the affected pancreas straight into another part of the bowel. These operations will not help everybody but good results are normally observed in six or seven out of ten patients.
Other operations are sometimes required to correct the complications of chronic pancreatitis, such as cyst formation. Cysts may need draining which can be done both surgically and endoscopically depending on the suitability of the cyst.
 
What research is needed?
Further research is needed on effective pain control in chronic pancreatitis and with better control of fat malabsorption that can occur. Research into the cyclical process of inflammation and fibrosis is needed - if this could be controlled it might be possible to prevent the progressive destruction of the pancreas. It is also important to find out why some people who drink alcohol are affected but others who seemingly drink similar amounts have no similar problems.
 
References:
1. http://pancreasmd.org/education_home.html
2. http://www.nhs.uk/conditions/Pancreatitis-chronic/Pages/Introduction.aspx
3. Biliary tract obstruction in chronic pancreatitis. Abdul A. Abdallah,1 Jake E. J. Krige,2 and Philippus C. Bornman 2007.
4. http://www.patient.co.uk/health/chronic-pancreatitis
5. Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion. 1993;54:148–155
6. http://pancreasfoundation.org/aboutpancreatitis/chronic-pancreatitis-diagnosis-and-treatment/
7. Gastroenterology. 2013 Jun;144(6):1282-91.e3. doi: 10.1053/j.gastro.2013.02.008.Management of chronic pancreatitis. Forsmark CE.
8. Surgical therapy in chronic pancreatitis. Neal CP, Dennison AR, Garcea G. Minerva Gastroenterol Dietol. 2012 Dec
 

Last Updated: 9th Mar 2015

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