Chronic pancreatitis is a long-term inflammation of the pancreas that leads to permanent damage and impairment of its structure and function. The pancreas is a gland located behind the stomach, responsible for producing digestive enzymes and hormones like insulin. Chronic pancreatitis disrupts these functions, leading to digestive problems and, in severe cases, diabetes.
Key Features
- Chronic Inflammation:
- Unlike acute pancreatitis, which is sudden and often reversible, chronic pancreatitis involves persistent inflammation.
- Progressive Damage:
- Over time, the inflammation causes scarring (fibrosis), calcification, and loss of pancreatic function.
- Exocrine and Endocrine Dysfunction:
- Exocrine dysfunction: Reduced production of digestive enzymes, leading to malabsorption.
- Endocrine dysfunction: Impaired insulin production, which may result in diabetes (referred to as pancreatogenic or Type 3c diabetes).
Causes
The primary causes include:
- Alcohol abuse (most common in adults).
- Genetic factors, such as mutations in the PRSS1 or CFTR genes (linked to cystic fibrosis).
- Autoimmune pancreatitis.
- Recurrent acute pancreatitis.
- Gallstones (less common in chronic cases).
- Obstruction of the pancreatic duct due to tumors or strictures.
- Idiopathic: In some cases, the cause is unknown.
Symptoms
- Persistent abdominal pain, often in the upper abdomen, radiating to the back.
- Steatorrhea (fatty, foul-smelling stools) due to fat malabsorption.
- Weight loss and malnutrition despite adequate food intake.
- Diabetes symptoms, such as increased thirst, frequent urination, or fatigue (in advanced stages).
- Nausea and vomiting during flare-ups.
Diagnosis
- Imaging Studies:
- CT Scan or MRI: Shows calcifications, ductal irregularities, or scarring in the pancreas.
- Endoscopic Ultrasound (EUS): Helps detect early changes in the pancreas.
- Function Tests:
- Fecal elastase test: Measures the amount of elastase enzyme in stool to assess exocrine function.
- Blood Tests:
- May show mild elevation of pancreatic enzymes during flare-ups.
- Glucose Tolerance Test:
- Evaluates for diabetes caused by pancreatic damage.
Treatment
- Lifestyle Modifications:
- Avoid alcohol and smoking (crucial for slowing disease progression).
- High-calorie diet with low fat and vitamin supplements to address malnutrition.
- Medications:
- Pancreatic enzyme supplements: Aid digestion and reduce steatorrhea.
- Pain management: Non-opioid analgesics initially; severe pain may require stronger medications or interventions.
- Insulin therapy: For managing diabetes.
- Endoscopic or Surgical Interventions:
- Drainage of cysts or removal of ductal obstructions.
- Pancreatic resection or procedures like the Puestow procedure in severe cases.
Complications
- Chronic pain: Can be debilitating.
- Malnutrition: Due to poor digestion and absorption of nutrients.
- Pancreatic insufficiency: Leads to severe digestive problems.
- Diabetes: Often irreversible in advanced stages.
- Pancreatic cancer: Increased risk over time.
Prognosis
Chronic pancreatitis is a progressive disease. While treatments can relieve symptoms and manage complications, the damage is irreversible. Early diagnosis and lifestyle changes can significantly improve quality of life and slow progression.