Chronic Pancreatitis

• What is chronic pancreatitis?
• What are the symptoms of chronic pancreatitis?
• What causes chronic pancreatitis?
• How is chronic pancreatitis diagnosed?
• What treatments are available for chronic pancreatitis?
• What is the outlook for people who have chronic pancreatitis?

Q. What is chronic pancreatitis?
A. Chronic pancreatitis is a progressive disease marked by ongoing inflammation of the pancreas. Over time, irreversible damage to pancreatic tissue occurs. Symptoms and complications vary from person to person, so treatments are tailored to each person's needs.

Q. What are the symptoms of chronic pancreatitis?
A. The symptoms of chronic pancreatitis include:

• Upper abdominal pain. Chronic upper abdominal pain and/or back pain are the most common symptoms of chronic pancreatitis. The pain may increase after drinking or eating, and lessens when sitting and leaning forward. However, some people with chronic pancreatitis report little to no pain.
• Nausea, vomiting
• Frequent, oily, foul-smelling bowel movements. Damage to the pancreas reduces the production of pancreatic enzymes that aid digestion, which can result in malnutrition. Fats and nutrients are not absorbed properly, leading to loose, greasy stool.
• Weight loss
• Diabetes. Chronic pancreatitis can affect the pancreas' ability to produce insulin to regulate glucose levels, leading to diabetes. Symptoms of diabetes include increased hunger and thirst, frequent urination, weight loss, and fatigue.

Q. What causes chronic pancreatitis?
A. While the exact cause of chronic pancreatitis remains somewhat of a mystery, we do know that the risk of developing chronic pancreatitis is increased by a number of factors, including:

• Alcohol consumption (the most frequent risk factor)
• Obstruction of pancreatic ducts due to injury, gallstones, or tumors
• Hereditary pancreatitis and other genetic factors such as mutations in the gene that causes cystic fibrosis
• Excess fat or calcium in the blood
• Autoimmune destruction of the pancreas (automimmune pancreatitis, also known as lymphoplasmocytic sclerosing pancreatitis)

Q. How is chronic pancreatitis diagnosed?
A. University of Chicago Medicine physicians take a comprehensive approach to diagnosing chronic pancreatitis. Several factors help physicians determine the proper diagnosis. Your medical history provides an important basis for diagnosis.

A variety of tests are available to assess patients for chronic pancreatitis. These tests include:

• Blood and glucose tests
• Pancreas secretion tests, such as measurement of the pancreatic enzyme elastase in the stool (fecal elastase)
• A biopsy, where physicians will remove a small piece of pancreatic tissue for examination
• Abdominal X-ray. If the X-ray shows pancreatic calcification (tissue hardened by calcium deposits), the patient has chronic pancreatitis.
• Abdominal ultrasound exams, which use sound waves to create images of abdominal organs
• Computed tomography (CT) scans. Here, our radiologists offer 64-slice CT exams, which can produce superior three-dimensional images
• Endoscopic ultrasound (EUS), which uses a thin tube, called an endoscope, that is specially equipped with a device that emits and detects sound waves as they bounce off tissue. The device sends this data to a computer, which then creates an image of the tissue for evaluation. This test can also be combined with administration of the hormone secretin to get information about how well the pancreas is able to produce digestive fluid and empty this fluid into the intestine.
• Endoscopic retrograde cholangiopancreatography (ERCP), an exam performed by our interventional endoscopy experts. Like EUS, the physician inserts an endoscope down the throat and into the gastrointestinal tract. This instrument has a light and camera at the end of it to view inside the tract.
• Magnetic resonance cholangiopancreatography (MRCP). Magnetic resonance imaging uses a powerful magnetic field and radiofrequencies to create images of the pancreas, its ducts, and the surrounding organs. This test can be combined with administration of the hormone secretin to measure pancreas function.
• Genetic testing is performed if it is suspected that you may have hereditary pancreatitis.

Not all tests are performed on every patient.

Q. What treatments are available for people who have chronic pancreatitis?
A. Because each case is different, treatment is tailored according to symptoms and the cause of the chronic pancreatitis. Most treatment plans include therapies to manage pain, as well as the use of medicines and procedures to compensate for poor pancreatic function to insure proper nutrition. Because some patients with chronic pancreatitis develop diabetes, proper management of that condition with insulin and diet modifications is important.

Treatments for chronic pancreatitis include the following:

• Alcohol avoidance. Drinking alcohol will worsen pancreatitis--especially in cases caused by excessive alcohol consumption. Avoiding alcohol will help reduce pain and lessen the risk for development of acute pancreatitis.
• Modified diet. Many patients will chronic pancreatitis feel better if they switch to a diet low in fat, and eat smaller, more frequent meals.
• Pancreatic enzyme supplements. Because the pancreas is not working properly, physicians prescribe pancreatic enzyme supplements to aid in digestion. These supplements help the digestion of food and may improve symptoms of fatty diarrhea (steatorrhea). In some patients, pancreatic enzymes may help alleviate pain by helping the pancreas rest.
• Pain-relieving medicines. Non-narcotic pain-relieving drugs, such as ibuprofen, can help relieve pain. When these medicines are not enough, narcotic analgesics are considered. These drugs are highly effective at relieving pain, but they also pose risks for drug dependency, so physicians prescribe them sparingly. When pain becomes so severe as to require high levels of narcotic pain medicine, it might indicate the need for a surgical procedure.
• Nerve blocks. Patients who do not respond to traditional pain-relieving measures may be candidates for a nerve block treatment. This therapy involves the injection of a powerful nerve-blocking substance directly into the nerves that carry pain signals from the pancreas. Although a nerve block usually provides only temporary relief of symptoms, there are a number of situations where it is useful to consider this alternative.
• Stenting of the pancreatic duct. Many patients with chronic pancreatitis have narrowed pancreatic ducts. Our gastrointestinal interventional endoscopy physicians can perform a procedure to insert a flexible plastic tube into the duct to prop it open. This procedure can relieve pain in some people.
• Removal of pancreatic duct stones. If pancreatic duct stones are present, these stones can be removed via a variety of minimally invasive techniques performed in the interventional endoscopy lab.

Surgery. If other therapies are not sufficient at relieving pain and improving pancreatic function, our physicians may recommend an operation. It is estimated that more than 50% of people with chronic pancreatitis may benefit from surgical intervention.

There are a variety of surgical procedures used to treat chronic pancreatitis. Our surgeons at the University of Chicago assess each situation individually to determine the best approach that will relieve abdominal pain, improve drainage of pancreatic secretions, and reduce the chance for future attacks of pancreatitis.

Some patients may benefit from a pancreatic resection (surgical removal of part or all of the pancreas). Others may benefit from a decompressive procedure that relieves pressure within the pancreatic ducts. A combined approach that involves both decompressive treatments and resection may also be considered. A number of advanced procedures are performed at the University of Chicago, including:

• Whipple procedure (removal of the head of the pancreas and duodenum)
• Duodenum-sparing pancreatic head resection, including the Beger procedure, the Frey procedure, and the Bern modification.
• Spleen-preserving pancreatic tail resection (distal pancreatectomy)
• Minimally invasive (laparoscopic) pancreatic operations, such as pseudocyst drainage and distal pancreatectomy. Benefits of minimally invasive surgery include small incisions, less scarring, and, often, a faster recovery.

If resection (removal) of the entire pancreas (total pancreatectomy) is advised, some patients may be eligible for autologous islet cell transplantation (AIT), a highly specialized procedure, offered in only a few centers worldwide. AIT prevents or reduces the effects of diabetes after pancreas removal. In the past, surgeons were hesitant to remove the pancreas because patients normally developed difficult-to-control diabetes, also referred to as "brittle diabetes," after surgery. The risk of diabetes posed problems that sometimes outweighed the benefits of pancreas resection. But today, the University of Chicago Medicine and a handful of other U.S. hospitals can offer AIT so that patients with pancreatitis can undergo pancreas resection to alleviate severe pain without the fear of developing brittle diabetes. »Learn more about autologous islet cell transplantation

At the University of Chicago, our specialists are among the nation’s most experienced pancreatic surgeons, with respect to both the range of alternatives offered and the number of procedures performed. Studies show that patients who have had pancreatic resections at experienced hospitals like the University of Chicago Medicine fare better than people who have the same procedure at smaller hospitals with a lower volume of cases.

Q. What is the outlook for people who have chronic pancreatitis?
A. Every case of chronic pancreatitis is different--depending upon the cause, extent of the disease, and the overall health of the patient. Some people experience problems for months or years.

It's important to know that if you have chronic pancreatitis, there is a lot you and doctor can do to improve how you feel. Be sure to stop drinking alcohol and follow your physician's instructions for a diet that can alleviate some symptoms. Take your medications as prescribed to help reduce pain and encourage healing of the pancreas.

More Information

• Acute Pancreatitis
• Chronic Pancreatitis
• Hereditary Pancreatitis
• Autologous Islet Cell Transplantation
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