What is chronic pancreatitis?

Living with chronic pancreatitis can be a challenge, and understanding its symptoms is important when it come to treatment. Long-term pancreas inflammation impacts daily life, causing persistent chronic pain and digestive issues. Acute pancreatitis on the other hand is a short-term condition, but repeated episodes of acute pancreatitis leads to chronic pancreatitis. Let’s explore the signs and symptoms of chronic pancreatitis, shedding light on this condition that affects thousands of people worldwide.

Common symptoms of chronic pancreatitis

Chronic pancreatitis symptoms can vary from person to person, but we often see some common signs in patients. Let’s explore these symptoms in detail.

Abdominal pain

The most common symptom seen in chronic pancreatitis is abdominal pain. This pain typically occurs in the upper abdomen, just below the ribs, and can range from mild to severe. In some cases, we’ve seen the pain spread into the back. Interestingly, some patients find relief by leaning forward or sitting up. The pain may be constant or come and go, often worsening after meals.

Digestive issues

Chronic pancreatitis has a significant impact on digestion. We’ve observed that many patients experience nausea, vomiting, and diarrhoea. A telltale sign we look for is steatorrhea – large volumes of loose, pale, and foul-smelling stools that are difficult to flush. The damaged pancreas struggles to produce enough digestive enzymes, leading to poor fat absorption.

Weight loss

Unintentional weight loss is another common symptom we see with chronic pancreatitis. This occurs due to a combination of factors. The pain and discomfort often reduces appetite, causing patients to eat less. Additionally, the pancreas’s inability to produce sufficient digestive enzymes results in malabsorption of nutrients. We’ve found that this weight loss can have serious health implications, including increased risk of infections, loss of muscle mass, and slower healing.

In our experience, these symptoms can significantly impact a person’s quality of life. It’s crucial to seek medical attention if you’re experiencing these signs, as early diagnosis and treatment can help manage the condition more effectively.

Causes and risk factors

Chronic pancreatitis has multiple causes and risk factors. Let’s explore the most common ones.

Alcohol abuse

Long-term alcohol use is the most common cause of chronic pancreatitis, responsible for about 7 out of 10 cases. We’ve observed that heavy drinking over several years can repeatedly damage the pancreas. However, it’s important to note that only a minority of people who regularly consume alcohol develop this condition. The risk increases with the amount and duration of alcohol consumption, typically manifesting in men aged 30-40 who are long-term heavy drinkers.

Genetic factors

Genetics plays a crucial role in hereditary pancreatitis. Mutations in genes like PRSS1, SPINK1, and CFTR can increase susceptibility to the condition. The CFTR gene is responsible for cystic fibrosis. Genetic factors often interact with environmental stressors, making the disease truly complex.

Other causes

There are various other causes of chronic pancreatitis. These include gallstones that cause a blockage of the pancreatic duct, autoimmune disorders (autoimmune pancreatitis), where the body’s immune system attacks the pancreas, metabolic disorders and trauma. Smoking is another significant risk factor, potentially even more so than alcohol. Additionally, we’ve observed that hypertriglyceridemia can increase the risk of developing chronic pancreatitis symptoms.

Diagnosis

Diagnosing chronic pancreatitis can be challenging, especially in its early stages. To establish a clear diagnosis, we rely on a combination of imaging tests, blood tests, and pancreatic function tests.

Imaging tests

A CT scan (computed tomography) is often the initial imaging test we use. It provides detailed views of pancreatic morphology and can detect changes seen in advanced chronic pancreatitis. CT scans are particularly useful in identifying complications such as pseudocysts and biliary obstruction.

Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) techniques offer excellent visualisation of both the pancreatic parenchyma and ducts. These techniques are especially helpful in detecting subtle ductal changes and assessing pancreatic exocrine function.

Endoscopic ultrasound (EUS) has become an invaluable tool in diagnosis. It allows us to detect early parenchymal and ductal changes that might not be visible on CT or MRI scans.

Blood tests

When we suspect chronic pancreatitis, we typically order blood tests to measure levels of pancreatic enzymes. Amylase and lipase are the most common enzymes we check. However, we’ve learned that these tests have low sensitivity for chronic pancreatitis, as enzyme levels may be normal or only slightly elevated in long-standing cases.

Pancreatic function tests

To assess pancreatic exocrine function, we often use faecal elastase-1 testing. This non-invasive test measures the amount of elastase enzyme in the stool. We’ve found it to be particularly useful in detecting advanced pancreatic insufficiency.

Treatment options

We’ve found that managing chronic pancreatitis symptoms involves a multi-faceted approach. Our treatment strategies focus on alleviating pain, improving digestive function, and addressing lifestyle factors that contribute to the condition.

Pain management

Pain control is central to treating chronic pancreatitis. We typically start with mild pain relief like paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs). If these aren’t effective, we may prescribe stronger medications such as opioids. However, we’re cautious about long-term opioid use due to the risk of dependence. In some cases, we recommend nerve blocks or surgical interventions to relieve severe, persistent pain.

Enzyme replacement therapy

Many patients with chronic pancreatitis have difficulty digesting food due to insufficient enzyme production. We often prescribe pancreatic enzyme supplements to help with this issue. These supplements contain lipase, amylase, and protease, which assist in breaking down fats, carbohydrates, and proteins. It is typically advised to take these enzymes with every meal and snack to improve how you digest food, absorb nutrients and reduce symptoms like diarrhoea and weight loss.

Lifestyle changes

We strongly encourage patients to make significant lifestyle modifications to manage their chronic pancreatitis symptoms. The most crucial change is to stop drinking alcohol, even if it wasn’t the primary cause of the condition. Continuing to drink can lead to more severe complications and potentially life-threatening situations. We also advise patients to quit smoking, as it can accelerate pancreatic damage and increase the risk of pancreatic cancer. Additionally, we recommend maintaining a healthy diet low in fat and high in nutrients to support overall pancreatic function and prevent complications like diabetes.

Complications of chronic pancreatitis

• Pancreatic pseudocysts: the pancreatic duct that feeds pancreatic juices to your intestine is damaged causing fluid to form into a cyst
• Diabetes: this is due to the pancreas being unable to make insulin. Insulin controls blood sugar
• Jaundice: blockages of the bile duct by gallstones prevent bile from getting into the gut and leaking into the bloodstream

Conclusion

Understanding chronic pancreatitis has a significant impact on managing this complex condition effectively. We’ve looked at the common symptoms, including abdominal pain, digestive issues, and weight loss, as well as the various causes and risk factors. The diagnostic process involves a combination of imaging tests, blood tests, and pancreatic function tests to accurately identify the condition. Treatment options focus on pain management, enzyme replacement therapy, and crucial lifestyle changes to improve the quality of life for those affected. With the right treatment and support, many people with chronic pancreatitis can lead fulfilling lives despite the challenges they face.

Sources

• Chronic pancreatitis – NHS inform
• Pancreatitis: Symptoms, Causes & Treatment
• Chronic Pancreatitis – StatPearls – NCBI Bookshelf
• Chronic Pancreatitis – National Pancreas Foundation
• Chronic pancreatitis – Guts UK