The pancreas is an organ located behind your stomach. It makes enzymes that help in the digestion of food. It also makes hormones that control the blood sugar level.
What is chronic pancreatitis?
Chronic pancreatitis is an inflammation of your pancreas which causes progressive destruction of the gland. It can lead to permanent damage to the gland.
As result stones and cysts may develop in your pancreas, which in turn block the tube that carries digestive juices to your intestine. It thus becomes harder for your body to digest food and regulate blood sugar. This can cause malnutrition and diabetes. However, the most bothering symptom is severe upper abdominal pain which recurs and impairs social life. It also has a profound impact on education and employment patterns because of the age group it affects.
Painful episodes can last for hours or even days. Some people find that eating or drinking can make their pain worse. As the disease progresses, the pain may become constant.
Fatty stools (bulky stool which cannot be flushed easily) could be a sign that your body isn’t absorbing nutrients correctly.
What causes Chronic Pancreatitis?
- Alcohol consumption (this is the most common cause)
- Nicotine consumption like smoking.
- Nutritional factors (high fat and protein in diet, hypertriglyceridemia which is a high level of triglyceride fats in your blood)
- Hereditary factors (like cystic fibrosis)
- The narrow or blocked pancreatic duct, which is the tube that carries enzymes from the pancreas to the small intestine
- Autoimmune disease, which occurs when your body mistakenly attacks your healthy cells and tissues
How to diagnose chronic pancreatitis?
It is difficult to diagnose chronic pancreatitis in early stages. As the disease progresses there are structural changes in the pancreas that can be reliably picked up with the help of tests like ultrasound, CT scan, MRI scan and endoscopic ultrasound (EUS). Over the years there has been a significant development in various imaging techniques used for diagnosis of this disease. These tests have replaced many difficult and painful tests that were used previously.
Blood tests typically aren’t used to diagnose the disease. However, they may be used to diagnose and monitor diabetes associated with this condition. Simpler stool tests like elastase estimation have replaced 24 hours of fat estimation tests used in yesteryears.
What are the complications of chronic pancreatitis?
This condition can cause blockage in the neighbouring organs like bile ducts (which causes jaundice), duodenum (a portion of the small intestine after stomach), colon, splenic vein (a vein draining the spleen, which can cause blood-filled sacs in the stomach and blood vomiting).
It can also cause fluid-filled sacs in the pancreas (pseudocysts) or cause rupture of the pancreatic duct (the tube that carries the pancreatic juices to the small intestine). Rupture of pancreatic duct results in the accumulation of juice in the abdomen or chest. Chronic pancreatitis can also lead to pancreatic cancer in the long run.
What is the treatment of chronic pancreatitis?
Treatment can be medical, endoscopic or surgical. Treatment cannot cure the disease it can address the symptoms and complications associated with the disease.
The most important component of treatment is absolute alcohol and nicotine abstinence. If a patient continues to drink alcohol or smoke no matter what the treatment is being offered symptoms will never disappear.
As pain is the principal complain pain killers are the most commonly prescribed medicines. Gradually the dose and type of pain killers are changed if the pain does not respond to one type of painkillers. However, pain-killing drugs (like opiods) should not be consumed for a long time as they have their own side effects. If the pain does not get controlled it is time to take the help of other forms of treatment like endoscopic therapy or surgery.
Other useful medications generally prescribed are antidepressants, pregabalin, antioxidants, pancreatic enzymes and multivitamins.
There have been significant advances in endoscopic therapy in recent years. Endoscopic stenting, clearing the main pancreatic ducts of stones, breaking stones before clearing them by using ESWL technique are all various means to treat a selected subgroup of patients.
Surgery is one of the most important components in the treatment of chronic pancreatitis. The most important reason to perform surgery is pain. An adequately performed surgery can relieve pain in approximately 80-90% of patients. It cannot reverse the disease process however. Such operations should ideally be carried out at centres where it is performed routinely because incompletely performed procedures do not result in desired pain control.
Surgery is also indicated to relieve obstruction caused by the disease process in the neighbouring organs and for the treatment of cancer-associated with the disease.
Dr. Pankaj Kumar Sonar, Consultant – Liver Transplant & GI Surgeon, RTIICS Kolkata
