November 3rd, 2010
08:32 AM ET

What is chronic pancreatitis?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesday, it's Dr. Otis Brawley, a chief medical officer for the American Cancer Society.

Question asked by Carolyne of Massachusetts:

Could you give me a brief outline of chronic pancreatitis? My husband has recently been diagnosed with this, yet the doctors tell us all the time it will get better when in fact it is getting worse. Thank you.

Expert answer:

Chronic pancreatitis is a progressive inflammation in the pancreas that results in permanent structural damage of the organ. Pancreatitis can lead to impairment of digestive enzyme production by the pancreas and, in severe cases, to lack of insulin production.

Lack of insulin production can lead to a form of diabetes that must be treated with insulin. Chronic pancreatitis is different from acute pancreatitis, in that the latter is usually nonprogressive and often occurs as one painful episode. However, there can be some overlap.

Recurrent attacks of acute pancreatitis can lead to chronic pancreatitis over a period of years. Chronic pancreatitis can be asymptomatic, with occasional painful flares, while acute pancreatitis is almost always painful.

Most chronic pancreatitis is caused by:

• Alcohol abuse

• Genetic causes (mutations in the cystic fibrosis gene, hereditary pancreatitis)

• Obstructions of the bile ducts because of gallstones, malformations, trauma or tumors.

• Tropical pancreatitis, which is poorly understood and rarely seen outside of India.

• Systemic disease such as hypertriglyceridemia, possibly hyperparathyroidism

• Autoimmune pancreatitis associated with rheumatological diseases such as systemic lupus erythematosus, Sjögren's syndrome and primary biliary cirrhosis.

Studies show that one can decrease the risk of painful flare-ups by consuming small meals low in fat and maintaining good hydration. Abstinence from alcohol is important even among those whose pancreatitis is not caused by alcohol.

Drugs to lower gastric acidity are also useful. This can be either an H2 receptor blocker such as ranitidine or a proton pump inhibitor such as omeprazole. These drugs reduce the inactivation of the supplemental pancreatic enzymes from gastric acid.

Treatment of chronic pancreatitis can also be aimed at its cause. Ductal stones can be treated with sound wave therapy (lithotripsy) or by endoscopic or surgical removal. Malformed bile ducts can sometimes be surgically corrected. Very rarely, surgical removal of the pancreas is performed. Patients with rheumatologic or systemic illnesses often improve when their illness is brought under control.

When there is an acute flare-up of pain from chronic pancreatitis, it is common to rest the pancreas. One can minimize pancreatic digestive activity by first not feeding the patient for several days.

Giving pancreatic enzyme supplementation with meals is another form of pancreatic rest. Both may reduce pain and irritation, but analgesics are often needed. Common pain medications are the opioids or drugs designed to reduce neuropathic pain such as amitriptyline or nortriptyline. Occasionally, nerve blocks are used to treat frequently recurring pain.

Special attention needs to be paid to nutrition in patients who have long-term chronic pancreatitis. These patients have difficulty absorbing fat. As a result, they do not absorb enough calories, nor do they absorb fat-soluble vitamins. After a long period, there will be deficiencies in fat-soluble vitamins (A, D, E, K and B-12).

They will need vitamin injections and may need to be fed medium-chain triglycerides (MCTs) for additional calories. MCTs are less likely to cause a flare, compared with long-chain triglycerides.

soundoff (21 Responses)
  1. E. Hillmann

    Attention should also be paid to lack of pancreatic enzyme production that may develop and result in frequent loose stools. Enzymes can be replaced by taking a specific drug.

    November 3, 2010 at 09:08 | Report abuse | Reply
  2. Heath

    Our family was greatly affected by this disease. Years of hospitilization and complications for my Mother. I can tell you that it did get better.....MUCH better, but it took time. She still has issues that are controlled with diet and has not been hospitalized in over a decade.

    November 3, 2010 at 11:05 | Report abuse | Reply
  3. Aaron

    I had this for years – and ended up 20 years later with diabetes – but treated with oral meds and diet for now. No one ever found out "why" mine flared up – wasn't a heavy drinker.

    November 3, 2010 at 11:45 | Report abuse | Reply
  4. Jackie

    My mother has had chronic pancreatitis her whole life. It wasn't until I was 5-6 years old that they found out what was wrong with her (I'm 21 now). She suffers from the genetic mutation listed in this article. I can not begin to imagine what it would be like to be in constant pain, with varying intensities. She is rarely 100% without pain. She takes digestive enzymes with every meal and I definitely thank medical science for that. Good luck to all who suffer from this!

    November 3, 2010 at 12:27 | Report abuse | Reply
  5. Mike C.

    My wife was diagnosed with this at an early age and it is dissappointing that every story about this disease makes the alcohol abuse angle a main focal point. The patients that are not addicts get the label and it frustrating. HEY DOCTORS, pay attention and help those who didn't inadvertantly ask for this disease, ok?

    November 3, 2010 at 12:29 | Report abuse | Reply
  6. Barbara Morse

    I too suffered with chronic pancreatitis even though I do not drink. When I began following a gluten free diet, my pancreas healed and the pancreatitis has never returned.

    November 3, 2010 at 13:03 | Report abuse | Reply
  7. rush

    I had a buddy back in the late 80's who got sick from this and ended up in the hospital. Of course I had no idea what it really meant back then but I have a greater understanding now and it was a big mess when he had the issues. I had a bit of junk happening in my life and I didnt give him the full attention that my friend should have gotten. I hope he doesnt have any residual problems since then. Its been a long time.
    Hope things are well for you Boog. You were my best friend then and Im sorry we got seperated thru the years.

    November 3, 2010 at 13:06 | Report abuse | Reply
  8. Improve Concentration

    Its when – pancreatitis happens regularly

    November 3, 2010 at 20:17 | Report abuse | Reply
  9. Judanna di Peppo L. Ac.

    Could you perhaps Piggy Back this article with a piece on SOD (Sphincter of Oddi Dysfunction) ie. It's symptoms, overlapping quantitative results & diagnosis with Chronic Pancreatitis as well as whether ERCP is Curative or Pallitive care & how Pancreas Divisum causes SOD ?
    Thank you Drs. Sanjay & Otis Brawley

    November 3, 2010 at 22:28 | Report abuse | Reply
  10. Brenda Dye

    I've been diagnosed with chronic pancreatitis. It's been a few months and I still feel awful. Does anyone know of someone who went on disability for this disease. I need help. Thank you.

    November 9, 2010 at 14:52 | Report abuse | Reply
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