What are the other Names for this Condition? (Also known as/Synonyms)

• Chronic Inflammation of Pancreas

What is Chronic Pancreatitis? (Definition/Background Information)

• Chronic Pancreatitis is inflammation of the pancreas that results in an alteration of its normal structure, causing it to function in an irreversible manner
• Chronic Pancreatitis affects both genders, although men are reported to be more susceptible to the condition. The onset of the condition is usually the mid-30s
• Several risk factors are reported that could increase susceptibility to the disease. Some of them include alcohol use, smoking, hyperparathyroidism, use of certain medicines, and certain autoimmune disorders. In some instances, the disease is reported to run in families, implying an inherited risk of the disease in this group of individuals
• The cause of Chronic Pancreatitis is the excess synthesis of extracellular matrix proteins, which is typically a response to injury. This leads to scarring of the pancreatic tissue. Since the pancreas are involved in the digestion process by supplying needed enzymes and are also the site of synthesis of insulin, several key processes in the body could get impaired
• Typical symptoms of Chronic Pancreatitis include pain in the upper abdomen, which could be continuous as the disease progresses. One could also experience pain after eating food or drinking something, as well as pain in the back. Fatty stools, diarrhea, vomiting, malabsorption of nutrients leading to weight loss, etc., are some other associated symptoms
• Apart from a physical examination and assessment of medical history, a healthcare provider could use a variety of methods to diagnose Chronic Pancreatitis. Blood and stool tests and certain imaging procedures may be necessary to arrive at an accurate diagnosis
• Chronic Pancreatitis is treated by using pain medication, replenishing fluids intravenously, managing digestive symptoms by adhering to a strict diet with low fat, reduced caffeine, and increased calcium intake
• Many complications could arise in individuals with Chronic Pancreatitis. These include fluid accumulation in the stomach and pancreas, obstruction of the small intestine, and chronic weight loss
• When an individual is in the initial stages (acute pancreatitis rather than chronic), a prompt and proper treatment could prevent the condition from progressing to its chronic form. Additionally, abstinence from alcohol could prevent the condition from occurring
• Chronic Pancreatitis causes irreversible damage to the pancreas. Therefore, the condition can cause serious damage to one’s health and may even be fatal

Who gets Chronic Pancreatitis? (Age and Sex Distribution)

• Chronic Pancreatitis is reported to predominantly develop in adults in the age group of 30-40 years
• Chronic Pancreatitis occurs in both genders. However, men are more often affected than women

What are the Risk Factors for Chronic Pancreatitis? (Predisposing Factors)

The following are some risk factors that could make an individual more susceptible to Chronic Pancreatitis:

• Alcohol (most common cause in developed countries)
• Malnutrition (especially in tropical countries)
• Heredity factors: Chronic Pancreatitis has been shown in a small group of patients to be inherited in autosomal dominant fashion
• Trypsinogen and inhibitory protein defects
• Cystic fibrosis
• Trauma
• Hypercalcemia and hyperparathyroidism
• Calcific stones
• Autoimmune disorders - when the immune system attacks the body

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chronic Pancreatitis? (Etiology)

• Chronic Pancreatitis ensues as a result of excess synthesis of the extra-cellular matrix proteins, known as pancreatic fibrogenesis, a typical response to injury
• Distinct chemical mediators (chemokines) are involved in the initiation and perpetuation of Chronic Pancreatitis
• The fibrogenesis results in scarring of the pancreatic tissue
• The pancreas is the site of synthesis of insulin and key enzymes involved in the digestive process. Any damage to the organ, therefore, results in a multitude of symptoms

What are the Signs and Symptoms of Chronic Pancreatitis?

The damaged pancreas in Chronic Pancreatitis could lead to symptoms such as:

• Pain
  • Abdominal pain, greatest in the upper abdomen, may last from hours to days, eventually may become continuous and may get worse from eating or drinking or after consuming alcohol 
  • Pain may also be felt in the back
  • Pain can be related to food intake, especially those meals that are rich in fat and proteins
• Fat in stool (steatorrhea)
• Weight loss, due to malabsorption, reported in a large percentage of patients

How is Chronic Pancreatitis Diagnosed?

A healthcare provider might require many of the following to diagnose Chronic Pancreatitis:

• Physical examination and assessment of symptoms
• A record of personal and family medical history; learning of habits such as excess alcohol drinking, smoking, and other factors
• Blood tests: To check for the level of enzymes such as serum amylase, serum lipase, and serum trypsinogen
• Blood test to check for serum IgG4, to ascertain or rule out autoimmune pancreatitis
• A secretin stimulation test: It is considered the gold standard functional test for diagnosis of Chronic Pancreatitis, but is not often used clinically
• Stool test: Fecal elastase measurement in stool to check pancreatic function (a less invasive test), fecal fat contents test
• Imaging methods, such as computed tomography (CT scan), ultrasound, endoscopic ultrasound, magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP). Pancreatic calcification can often be seen on plain abdominal x-rays, as well as CT scans
• Non-specific lab tests: Other non-specific laboratory tests include elevated serum bilirubin, alkaline phosphatase indicating stricture of common bile duct due to edema, fibrosis or cancer.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chronic Pancreatitis?

Some complications from Chronic Pancreatitis include:

• Building up of fluid in the abdominal space, known as ascites
• Fluid accumulation in the pancreas, known as pancreatic pseudocysts
• Infection of pancreatic pseudocysts
• Obstruction of small intestine and bile ducts
• Blood clot in the vein of the spleen
• Pleural effusion or fluid build-up around the lungs
• Splenic vein thrombosis with portal hypertension and pseudoaneurysm (hematoma that forms as a result of leaking holes in the artery) formation of the splenic artery

Impaired pancreatic function that could can lead to

• Diabetes
• Poor absorption of nutrients and fat
• Vitamin malabsorption (most often the fat soluble vitamins A, D, E or K)
• Malnutrition
• Disability and mood disturbances

How is Chronic Pancreatitis Treated?

Generally, the treatment for Chronic Pancreatitis is undertaken by medical measures, therapeutic endoscopy and surgery.

• When possible, treatment is directed at managing the underlying cause of the condition to offer relief from pain and malabsorption
• Medical measures include food ingestion by mouth: Giving fluids through intravenous route and gradually re-introducing food to be taken by mouth
• If a patient develops insulin-dependent diabetes mellitus, insulin therapy may be required
• Medication for pain relief may be prescribed, which might include narcotics (for severe pain)  
• Pancreatic enzyme supplementation (to make up for loss of pancreatic function) to aid in digestion
• Diet is an important consideration in the treatment of Chronic Pancreatitis. The diet should be low fat and rich in vitamins and minerals
• Generally, eating frequent small meals is suggested, in order to reduce digestive symptoms
• Reduced caffeine intake  and drinking plenty of fluids is recommended
• Inserting a tube (nasogastric tube) through the nose into the stomach; this tube may stay in place from 1 day to 2 weeks as necessary

Surgery performed for Chronic Pancreatitis can be classified as resection and drainage procedure. Transplantation of a patient’s own beta cells following resection can help prevent occurrence of diabetes. If the condition is severe, part of the scarred pancreatic tissue may be removed surgically.

How can Chronic Pancreatitis be Prevented?

• When an individual is diagnosed with acute pancreatitis, prompt treatment could help prevent progression of the condition to Chronic Pancreatitis
• Abstaining from alcohol or restricting the amount of alcohol consumed could potentially reduce the possibility of getting Chronic Pancreatitis

What is the Prognosis of Chronic Pancreatitis? (Outcomes/Resolutions)

• The prognostic factors associated with Chronic Pancreatitis are age at diagnosis, smoking, continued use of alcohol, and the presence of liver cirrhosis
• The overall rate of survival is 70% at 10 years and 45% at 20 years..
• Since Chronic Pancreatitis causes irreversible damage to the pancreas, the condition can be fatal

Additional and Relevant Useful Information for Chronic Pancreatitis:

The fecal fat stool test determines levels of fat in the stool. It is used to diagnose fat malabsorption so that its underlying causes may be investigated.