Chronic pancreatitis is a chronic inflammation of the pancreas that deteriorates with time and leads to irreversible damage of the pancreas and eventually pancreatic failure.

The most common cause of chronic pancreatitis is alcohol abuse. Other causes include pancreatic or common bile duct stones, genetic mutations such as cystic fibrosis, and autoimmune diseases such as lupus1, among others. The cause from some cases is unidentified cause.

Factors that may increase the risk of developing chronic pancreatitis include smoking, being male and being between 30 and 40.

In chronic pancreatitis, the pancreatic tissue is replaced by fibrous tissue and scarring as a result of injury. Over time this leads to pancreatic insufficiency where the pancreas is unable to produce enough digestive enzymes.

Chronic pancreatitis presents as abdominal pain that radiates to the back. The pain is usually not sudden and becomes worse with time. Other symptoms may include vomiting, diarrhea, nausea, and weight loss.

Lab tests and imaging studies are used to diagnose chronic pancreatitis. The patient’s blood may be tested for levels of enzymes like lipase and for levels of calcium and triglycerides. A CT scan may be helpful to identify any complications; however, endoscopic retrograde cholangiopancreatography is the standard method used to diagnose this disease.

Treating chronic pancreatitis depends on the severity of the disease and the cause of pancreatic injury.  In patients with chronic pancreatitis caused by alcohol, the first step in treatment is stopping alcohol consumption. Patients are usually provided with IV fluids and painkillers in addition to being placed on a low fat diet. In advanced cases surgery or pancreatic enzyme supplements may be required.

Some of the complications of chronic pancreatitis that may appear include malabsorption and diabetes due to pancreatic insufficiency. In addition the risk of developing pancreatic cancer increases.

Factors that may reduce the risk of developing chronic pancreatitis include limiting alcohol consumption and quitting smoking.

Since the damage caused by chronic pancreatitis is irreversible, patients living with chronic pancreatitis usually experience chronic pain and malabsorption. As such, these patients tend to have a reduced life expectancy. Age at diagnosis, smoking, continued use of alcohol, and the presence of liver are all factors that influence the prognosis.

According to a study published in the Journal of the American Gastroenterological Association, Gastroenterology, the prevalence of chronic pancreatitis is 50/100,000 people and the incidence is estimated to be between 5 to 12/100,000 people.

It is a chronic inflammation of the pancreas that gets worse with time and leads to fibrosis of the pancreas and eventually pancreatic failure.

Alcohol abuse is the most frequent cause of chronic pancreatitis. Other possible causes that may lead to chronic pancreatitis include pancreatic or common bile duct stones, genetic mutations such as cystic fibrosis, autoimmune diseases such as lupus, hyperparathyroidism, hypercalcemia, and hypertriglyceridemia. It may also be caused by hereditary factors. Rare causes include injury to the pancreas, blocked or narrowed ducts of the pancreas, smoking and radiotherapy to the abdomen. Some cases are idiopathic.

Cigarette smoking is a risk factor for developing chronic pancreatitis .  Chronic pancreatitis often occurs in patients between the ages of 30 and 40. The diseases is more common in men.

Regardless of the initial cause of pancreatic injury, the end result of chronic pancreatitis is the replacement of pancreatic tissue with fibrous tissue and scarring. Over time this results in the pancreas becoming unable to produce the necessary amount of digestive enzymes.

The pancreas contains both exocrine and endocrine cells that release digestive enzymes and hormones, respectively. Exocrine pancreatic function usually fails before endocrine function. Endocrine function failure usually occurs as a result of advanced pancreatic fibrosis.

Most chronic pancreatitis patients complain of abdominal pain that radiates to the back. A significant portion of patients have been experiencing this pain for a while. The pain gets worse with time.

Other symptoms may be present and include nausea, vomiting, diarrhea and weight loss.

Patients with advanced cases of chronic pancreatitis may complain of symptoms of pancreatic insufficiency which include malabsorption, excess fat in feces and symptoms of diabetes.

Chronic pancreatitis is diagnosed through the following:

Medical History

Patients typically present with a history of chronic episodes of epigastric pain radiating to the back.

Laboratory tests

Serum levels of digestive enzymes lipase and amylase may be slightly elevated because of the significant pancreatic fibrosis that has occurred. Serum levels of the those digestive enzymes are usually highly elevated in acute cases.

Serum levels of trypsinogen, a preform of the digestive enzyme trypsin, is usually very low in chronic pancreatitis.

Hypercalcemia and hypertriglyceridemia may point towards the cause of chronic pancreatitis.

Imaging studies

Endoscopic retrograde cholangiopancreatography can provide accurate visualization of the pancreatic duct. It is considered the standard method for diagnosing chronic pancreatitis.

X-rays may reveal pancreatic calcification.

CT scanning is both sensitive and specific for diagnosing chronic pancreatitis. It may reveal calcification, dilation of the pancreatic ducts and various complications accurately.

Endoscopic ultrasonography may also be used.

Other tests

Pancreatic secretin stimulation test measures the digestive function of the pancreas. It is the gold standard for diagnosing pancreatic insufficiency.

Patients with advanced cases may show elevated fasting and random blood glucose levels and increased fat content in their feces.

Chronic pancreatitis is usually treated by stopping alcohol consumption, nutritional support, intravenous fluids and painkillers.  Patients should be placed on a low fat diet as they usually have fat malabsorption. The low fat diet may help decrease the symptoms.

Pancreatic enzyme supplements are important in advanced chronic pancreatitis cases with pancreatic insufficiency; these also help reduce the symptoms.

Therapeutic endoscopy may be essential to relieve an obstruction, such as stone removal, and a stent may be placed to decrease future obstruction.

Various surgical procedures are indicated for severe cases and cases that do not respond to treatment. Surgery usually aims to remove an obstruction, or to remove part of the pancreas or the whole pancreas.

Chronic severe pancreatitis cases may be complicated with pancreatic insufficiency causing malabsorption and diabetes.

Pancreatic edema and inflammation may cause common bile duct or duodenum obstruction.

Pancreatitis can also be complicated by abnormal accumulation of fluid in the abdominal cavity, splenic vein thrombosis, pancreatic leakage, and pancreatic pseudocysts, which are fluid collections rich in pancreatic enzymes.

Chronic pancreatitis cases carry higher risk of pancreatic cancer.

The disease usually causes psychological problems such as stress, anxiety or depression.

Limiting alcohol consumption and quitting smoking may reduce the risk of developing chronic pancreatitis.

The damage to the pancreas sustained as a result of chronic pancreatitis is permanent. Pain and malabsorption caused by the disease can be controlled by treatment options such as pancreatic enzyme supplements and surgery.

Patients with chronic pancreatitis tend to have a reduced life expectancy. Factors closely associated with prognosis are age at diagnosis, smoking, continued use of alcohol, and the presence of liver cirrhosis.

A study published in the American journal of Gastroenterology found that overall survival at 10 years after diagnosis was 70% and overall survival at 20 years was 45%.

Older patients and those with alcoholic pancreatitis had a significantly higher risk of death. Smoking, drinking or development of liver cirrhosis also increased the risk of death.

A study published in the Journal of the American Gastroenterological Association, Gastroenterology, found that the prevalence of chronic pancreatitis is 50/100,000 people and the incidence is estimated to between 5 to 12/100,000 people.