After an attack of acute pancreatitis, the pancreas may completely recover or develop chronic pancreatitis. This is a permanent inflammation of the pancreas. It may have milder symptoms than acute pancreatitis. However, it is known for continuing stomach pain, food intolerance and disabling nausea.
Over time, pancreatitis can damage as much as 90% of the pancreas, making it hard to produce digestive enzymes and hormones. That results in diarrhea and poor absorption of nutrients. That, in turn, can lead chronic diarrhea, malnutrition and diabetes.
The clearest sign of chronic inflammation of the pancreas is pain. It can be severe at times, frequently seeming to go away as the disease progresses. In making a diagnosis, the doctor checks for signs of jaundice, weakness, emaciation, diarrhea and/or foul-smelling stools. Patients with a family history of pancreatitis, a history of alcohol abuse or several bouts of severe abdominal pain should be tested for chronic pancreatitis. The doctor will use one or more of the following:
- Blood tests to check the levels of two pancreatic enzymes, which tend to be high during an attack.
- Computed tomography (CT or "cat") scans or ultrasound, both of which can show inflammation and any scarring in soft-tissues. (CT uses an electronic beam to create a computerized image of internal organs, which X-rays can't capture. Ultrasound technology creates a sonogram, or an image created by sound waves, that shows the outlines of various organs and tissues in the body.)
- Endoscopic retrograde cholangiopancreatography (ERCP), a non-invasive procedure used to find and treat blockages in the pancreatic and biliary ducts.
Most cases of chronic pancreatitis are caused by alcohol abuse. The rest are from blockages caused by gallstones, surgical scarring, tumors or an abnormality in the pancreatic duct. Though rare, some cases develop from a genetic disorder or cystic fibrosis, one of the most common hereditary diseases. The GenRISK® Adult Genetics Program offers risk assessment for inherited diseases, counseling and recommendations about genetic testing and management of inherited conditions.
Screening and Prevention
As with acute pancreatitis, there is no way to screen for the disease. However, we do know that anyone who has had an acute alcohol-induced attack can reduce the risk by stopping or cutting down on the amount of alcohol he or she drinks. Patients with a family history of pancreatitis, a history of alcohol abuse or several bouts of severe abdominal pain should be tested for chronic pancreatitis.
Though there is no cure for chronic pancreatitis, some patients can reduce the symptoms and make up for nutritional deficiencies. Doctors often prescribe digestive enzymes and vitamin supplements. Patients who develop diabetes may have to take insulin shots and follow strict diets.
How severe symptoms are varies widely. In mild cases caused by alcohol abuse, the patient may be able to get relief by simply avoiding alcohol altogether. Those who do not give up drinking or fail to respond well to other treatments often live with disabling daily pain and make regular trips to the hospital.
Ordinarily, most pain can be relieved with over-the-counter medications, such as ibuprofen and acetaminophen. Some patients may need narcotics. In a few cases, where there are blockages, surgery or ERCP may open the blocked ducts or remove part of the pancreas.