Chronic Pancreatitis
- Persistent swelling over Pancreas over month or years is called Chronic Pancreatitis.
- Overtime, this leads to scarring and damage to parts of pancreas.
- This can lead to deficiency of digestive juices (enzymes) and chemicals called hormones (Example Insulin, Glucagon, etc) normally produced by Pancreas. This will cause indigestion, weight loss, diabetes and various other problems.
- Overtime, clumps of calcium deposit in Pancreas and its main tube/duct, causing stone formation and blockage of ducts.
- It is more commonly found in middle aged males
What are the symptoms of Chronic Pancreatitis?
- Abdominal/tummy pain – It starts in the middle, just below ribs and typically spreads to the back. It is persistent, partly eased by leaning forward. Eating often makes pain worse. This causes patient to eat less and hence lose weight. Pain can be intermittent, with periods of normal wellbeing.
- Poor digestion – Particularly, digestion of fats and certain vitamins is affected. This undigested fat is passed out with stools/faeces, making it to look pale, smelly, loose, difficult to flush (steatorrhea). Weight loss occurs due to poor digestion.
- Diabetes – Occurs in one-third cases, when pancreas cannot make enough Insulin. Symptoms are excessive thirst, passing large amount of urine, periods of low and high blood glucose levels, sudden dizziness and sweating, Ghabraman.
- Nausea-vomiting
- Alcohol-related chronic pancreatitis starts with acute pancreatitis with sudden onset severe pain episode. If habit continues, it can lead to pain again and again, ultimately damaging the pancreas.
What are the causes of Chronic Pancreatitis?
Alcohol – Most common cause. Generally, heavy drinking for 10 years or more leads to symptom development.
Smoking – Recently found to be linked to this disease
Genetic conditions – Some problems in patient’s genetic structure, passed through his/her family.
Autoimmune Conditions – Patient’s own immune system attacks the Pancreas
Uncommon causes –
- Structural problem in pancreas – like narrowing of duct due to various reasons
- Hereditary – Passed from parents
- Malnutrition – diet including cassava
- Unknown – no cause identified
How to diagnose Chronic Pancreatitis?
In early stages, diagnosis is difficult. Lot of damage to pancreas, calcium deposition, or significant decrease in digestive juices and hormones causes symptoms. A variety of tests may be required to be done according to the condition of patient.
- Blood tests
- Stool samples
- USG or CT scan
- MRCP (type of MRI)
- Endoscopy (EUS/Cholangiogram)
How is Chronic Pancreatitis treated?
- Lifestyle modification – Stop alcohol/smoking
- Pain relief with certain medications or nerve block injections
- Enzyme replacement therapy – Digestive juices given through tablets for helping digestion
- Fat restriction – decreasing fat amount in diet if producing stress over pancreas
- Insulin therapy – to control diabetes
- Vitamin therapy – for replacement of deficiency
- Steroids in autoimmune pancreatitis
- Sometimes, depending on treatment response, persistence of symptoms, or ongoing damage to pancreas, or due to disease complications, surgery may be required. There are various surgeries done according to the disease process and severity, which surgeon will explain in detail to the patient before the undertaking.
- Newer techniques under investigation are removal of whole of pancreas and transplantation of its cells in Liver.
What are the complications of Chronic Pancreatitis?
A variety of complications may occur in these patients
- Pseudocyst – Develops in around 25% patients. Pancreatic juice leaking from Pancreas collects in a pouch around it, putting pressure on surround organs. Sometimes, it goes away on its own, but sometimes need to be drained with a tube/pipe
- Ascites – There is collection of fluid all over the abdomen
- Blockage of bile duct – this causes jaundice making the patient look yellow
- Cancer of Pancreas – Risk increases in chronic pancreatitis. It is more in smokers and aged people
- Rarely, there may be blood clotting in surrounding blood vessels.
Can we expect good recovery in these patients?
Persistent damage to Pancreas will lead to some destruction which will not regrow again. But improving lifestyle, healthy diet with good hydration and exercise can lead to good long term outcome and good quality of life.
