Chronic pancreatitis
Pancreatitis is swelling of the pancreas. Chronic pancreatitis is present when this problem does not heal or recurs and does not improve, gets worse over time, and leads to permanent damage.
Causes
The pancreas is an organ located behind the stomach. It produces chemicals (called enzymes) needed to digest food. It also produces the hormones insulin and glucagon.
When scarring of the pancreas occurs, the organ is no longer able to make the right amount of these enzymes. As a result, your body may be unable to digest fat and key elements of food.
Damage to the parts of the pancreas that make insulin may lead to diabetes mellitus.
The condition is most often caused by alcohol abuse over many years. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be a factor in some cases. Sometimes, the cause is not known or caused by gall stones.
Alcohol abuse
Alcohol use involves drinking beer, wine, or hard liquor.
Read Article Now Book Mark ArticleOther conditions that have been linked to chronic pancreatitis:
- Problems when the immune system attacks the body
- Blockage of the tubes (ducts) that drain enzymes from the pancreas
- Cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a disease that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body. It is one of th...
Read Article Now Book Mark Article - High levels of a fat, called triglycerides, in the blood
- Overactive parathyroid gland
Overactive parathyroid gland
Hyperparathyroidism is a condition in which 1 or more of the parathyroid glands in your neck produce too much parathyroid hormone (PTH).
Read Article Now Book Mark Article - Use of certain medicines (especially sulfonamides, thiazides, and azathioprine)
- Pancreatitis that is passed down in families (hereditary)
Chronic pancreatitis is more common in men than in women. This often occurs in people ages 30 to 40.
Symptoms
Symptoms include:
ABDOMINAL PAIN
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
Read Article Now Book Mark Article- Greatest in the upper abdomen
- May last from hours to days; over time, may always be present
- May get worse from eating
- May get worse from drinking alcohol
- May also be felt in the back as if it is boring through the abdomen
DIGESTIVE PROBLEMS
- Chronic weight loss, even when eating habits and amounts are normal.
- Diarrhea, nausea, and vomiting.
- Foul-smelling fatty or oily stools.
- Pale or orange-colored stools.
Pale or orange-colored stools
Stools that are pale, clay, or putty-colored may be due to problems in the biliary system. The biliary system is the drainage system of the gallblad...
Read Article Now Book Mark Article - Chronic pancreatitis can lead to pancreatic cancer.
Exams and Tests
Tests to diagnose pancreatitis include:
- Fecal fat test
Fecal fat test
The fecal fat test measures the amount of fat in the stool. This can help gauge the percentage of dietary fat that the body does not absorb....
Read Article Now Book Mark Article - Increased serum amylase level
Serum amylase
Amylase is an enzyme that helps digest carbohydrates. It is made primarily in the pancreas and the glands that make saliva, and can be found at low ...
Read Article Now Book Mark Article - Increased serum lipase level
Serum lipase
Lipase is a protein (enzyme) released by the pancreas into the small intestine. It helps the body absorb fat. This test is used to measure the amou...
Read Article Now Book Mark Article - Serum trypsinogen
Serum trypsinogen
Trypsinogen is a substance that is normally produced in the pancreas and released into the small intestine. Trypsinogen is converted to trypsin. Th...
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Tests that may show the cause of pancreatitis include:
- Serum IgG4 (for diagnosing autoimmune pancreatitis)
- Gene testing, most often done when other common causes are not present or there is a family history
Imaging tests that can show swelling, scarring, calcifications or other changes of the pancreas may be seen on:
- CT scan of the abdomen
CT scan of the abdomen
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
Read Article Now Book Mark Article - Ultrasound of the abdomen
Ultrasound of the abdomen
Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and...
Read Article Now Book Mark Article - Endoscopic ultrasound (EUS)
- Magnetic resonance cholangiopancreatography (MRCP)
- Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP is a procedure that looks at your bile and pancreatic ducts. It is done through an endoscope.
ERCP
Abdominal exploration is surgery to look at the organs and structures in your belly area (abdomen). This includes your:AppendixBladderGallbladderIn...
Read Article Now Book Mark ArticleTreatment
People with severe pain or who are losing weight may need to stay in the hospital for:
- Pain medicines.
- Fluids given through a vein (IV).
- Stopping food or fluid by mouth to limit the activity of the pancreas, and then slowly starting an oral diet. Feeding the intestine is an important part of treating pancreatitis. If you can’t eat by mouth, a temporary feeding tube may be placed to give your intestine nutrients.
- Inserting a tube through the nose or mouth to remove the contents of the stomach (nasogastric suctioning) may sometimes be done. The tube may stay in for 1 to 2 days, or sometimes for 1 to 2 weeks.
Nasogastric suctioning
Gastric suction is a procedure to empty the contents of your stomach.
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The right diet is important for people with chronic pancreatitis to keep a healthy weight and get the correct nutrients. A nutritionist can help you create a diet that includes:
- Drinking plenty of liquids
- Limiting fats
- Eating small, frequent meals (this helps reduce digestive symptoms)
- Getting enough vitamins and calcium in the diet, or as extra supplements
- Limiting caffeine
The health care provider may prescribe pancreatic enzymes. You must take these medicines with every meal, and even with snacks. The enzymes will help you digest food better, gain weight and reduce diarrhea.
Avoiding smoking and drinking alcoholic beverages is very important, even if your pancreatitis is mild. This helps decrease your risk of pancreatitis and pancreatic cancer.
Other treatments may involve:
- Pain medicines or a surgical nerve block to relieve pain
- Taking insulin to control blood sugar (glucose) level
Blood sugar
A blood sugar test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of the...
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Surgery may be performed if a blockage is found. In severe cases, a part of or the entire pancreas may be removed.
Outlook (Prognosis)
This is a serious disease that may lead to disability and death. You can reduce the risk by avoiding alcohol.
Possible Complications
Complications may include:
- Ascites (build up of fluid in the abdomen)
Ascites
Ascites is the build-up of fluid in the space between the lining of the abdomen and abdominal organs.
Read Article Now Book Mark Article - Blockage (obstruction) of the small intestine or bile ducts
Bile ducts
Bile duct obstruction is a blockage in the tubes that carry bile from the liver to the gallbladder and small intestine.
Read Article Now Book Mark Article - Blood clot in the vein of the spleen
- Fluid collections in the pancreas (pancreatic pseudocysts) that may become infected (pancreatic abscess)
Pancreatic pseudocysts
A pancreatic pseudocyst is a fluid-filled sac in the abdomen that arises from the pancreas. It may also contain tissue from the pancreas, enzymes, a...
Read Article Now Book Mark Article - Diabetes
- Poor absorption of fat, nutrients, and vitamins (most often the fat-soluble vitamins, A, D, E, or K)
Poor absorption
Malabsorption involves problems with the body's ability to take in (absorb) nutrients from food.
Read Article Now Book Mark Article - Iron deficiency anemia
- Vitamin B12 deficiency
When to Contact a Medical Professional
Contact your provider if:
- You develop symptoms of pancreatitis
- You have pancreatitis, and your symptoms get worse or do not improve with treatment
Prevention
Finding the cause of acute pancreatitis and treating it quickly may help prevent chronic pancreatitis. Limit the amount of alcohol you drink to reduce your risk of developing this condition.
Acute pancreatitis
Acute pancreatitis is sudden swelling and inflammation of the pancreas.
Read Article Now Book Mark ArticleReviewed By
Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Forsmark CE. Chronic pancreatitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 59.
Forsmark CE. Pancreatitis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 130.
Price MD, Walsh CM, Makary MA. Management of chronic pancreatitis. In: Cameron J, ed. Current Surgical Therapy. 14th ed. Philadelphia, PA: Elsevier; 2023:541-545.
Van Buren G, Fisher WE. Acute and chronic pancreatitis. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2024. Philadelphia, PA: Elsevier; 2024:175-182.