Brief overview
- Symptoms: Radiating upper abdominal pain, loss of appetite, nausea, vomiting, fatty, malodorous stools, vitamin deficiency symptoms (for example, bleeding tendency, night blindness), diabetes.
- Causes and risk factors: In most cases, heavy alcohol consumption; less commonly, genetic causes, certain diseases or medications
- Treatment: abstinence from alcohol, low-fat and low-carbohydrate diet, painkillers, insulin therapy for diabetes mellitus, sometimes surgery.
- Course of the disease: If left untreated, the symptoms slowly worsen and significantly reduce the quality of life and life expectancy.
- Prevention: Avoid frequent alcohol consumption, as this is considered to be the most important cause.
What is chronic pancreatitis?
The disease often occurs in people in their third and fourth decade of life. In most cases, long-term alcohol consumption is the cause. Rarely, chronic pancreatitis develops in childhood. Then a genetic component usually plays a role.
What are the symptoms?
In addition to pain, chronic pancreatitis often triggers symptoms such as loss of appetite, nausea, vomiting and weight loss. Fatty foods in particular often cause problems. In addition, sufferers often have fatty, foul-smelling stools and suffer from flatulence.
In the advanced stage of chronic pancreatitis, the production of hormones for blood glucose regulation is also throttled: Insulin (lowers blood glucose levels) and glucagon (increases blood glucose levels). As a result, diabetes mellitus develops.
Causes and risk factors
Genetic causes (hereditary pancreatitis)
In hereditary pancreatitis, the pancreas becomes inflamed in childhood. A genetic defect leads to an altered structure and function of an endogenous substance that activates the digestive enzymes: Trypsinogen. As a result, the digestive enzymes are already activated in the pancreas and not only in the small intestine. They “digest” the pancreatic tissue, which results in an inflammatory reaction.
Medications
Some medications also sometimes trigger chronic pancreatitis. These include beta blockers, diuretics, ACE inhibitors, estrogens, or anti-epileptic drugs. Similar to alcohol, these drugs damage pancreatic tissue, causing it to become inflamed.
Excess calcium in parathyroid hyperfunction
Excess of triglycerides (hypertriglyceridemia).
An excess of certain blood fats (triglycerides) with values above 1000 milligrams per deciliter also causes chronic pancreatitis in rare cases. The exact mechanism behind this is not yet clearly known. Experts suspect that a cleavage of triglycerides (with the help of lipase) produces free fatty acids that cause inflammation of the pancreatic cells.
Autoimmune pancreatitis
Examinations and diagnosis
If chronic pancreatitis is suspected, it is best to consult your family doctor or a specialist in internal medicine and gastroenterology. A detailed description of the symptoms and any previous illnesses will provide the doctor with valuable information about your state of health (anamnesis). In addition, the doctor will inquire about, for example:
- Where exactly it hurts and whether the pain radiates outwards
- How much alcohol the affected person drinks or whether there is an alcohol dependence
- Whether the affected person suffers from shiny, greasy diarrhea
- Whether there has been a history of pancreatitis
- Whether elevated blood lipid levels or elevated calcium levels are known to exist
- Whether the affected person is taking medication
Physical examination
Blood test
During an acute inflammatory flare-up, pancreatic enzymes are often elevated in the blood. These include the fat-splitting lipase, the carbohydrate-splitting amylase and the protein-splitting enzyme elastase. However, blood levels of digestive enzymes are not elevated in all people with chronic pancreatitis.
Stool examination
A concentration of less than 200 micrograms per gram of stool indicates damage to exocrine pancreatic function. At an elastase concentration of less than 100 micrograms per gram of stool, physicians classify the functional disorder as severe.
Imaging procedures
To diagnose chronic pancreatitis, the physician performs an ultrasound examination of the abdomen (abdominal ultrasonography), magnetic resonance imaging (MRI) or computed tomography (CT). The imaging measures can be used to assess the extent of the tissue damage. Endoscopic retrograde cholangiopancreaticography (ERCP) can be used to determine whether a tumor in the pancreatic or bile duct is the cause of the symptoms.
Due to the recurrent inflammatory episodes, the pancreatic tissue becomes scarred over time and calcifications form. An ultrasound examination of the abdomen (abdominal ultrasonography) provides initial indications of this. If such calcifications are present, this is considered evidence of chronic pancreatitis. However, the pancreas often cannot be optimally visualized by a normal ultrasound examination because it is located in the abdominal cavity behind other organs.
Computed tomography and magnetic resonance imaging
If chronic pancreatitis is suspected, computed tomography (CT) provides a detailed image of the pancreas. Magnetic resonance imaging (MRI) provides even more accurate imaging.
Endoscopic retrograde cholangiopancreaticography (ERCP).
Because chronic pancreatitis sometimes causes a tumor (pancreatic cancer) as it progresses, in many cases the physician performs endoscopic retrograde cholangiopancreaticography (ERCP).
Genetic diagnostics
If there is a suspicion of genetic chronic pancreatitis, for example because people in the immediate family have already had the disease, a genetic analysis may be useful. In this case, those affected should seek advice from appropriate specialists.
Treatment
At least for people who are physically dependent on alcohol, the first step is detoxification in a clinic, where they overcome the physical withdrawal symptoms under medical supervision and, if necessary, with drug support. This is followed by further appropriate measures. These include outpatient or inpatient addiction therapy to get the psychological dependence on alcohol under control, and attendance at self-help groups to support the process.
In addition, the symptoms of chronic pancreatitis can be relieved with the help of medications and surgical procedures.
Chronic pancreatitis – medications
In the case of an acute inflammatory flare-up, pain therapy is the same as for an acute form of pancreatitis. Patients receive opioids for pain relief in the form of buprenorphine or pethidine.
In people with severe chronic pancreatitis, the pancreas is often so severely damaged that it no longer regulates blood glucose levels adequately. Those affected develop diabetes and then require additional insulin therapy.
Chronic pancreatitis – surgical procedures
The doctor inserts a small tube into the pancreatic duct. He then inserts a small balloon into the pancreatic duct and inflates it so that the duct expands again. In some cases, he also inserts a small tube (stent) that prevents the duct from narrowing again. The doctor shatters stones in the pancreatic duct using electrical shock waves to improve drainage.
Course and prognosis
Chronic pancreatitis – prognosis
Chronic pancreatitis usually runs its course over several years and is usually accompanied by other diseases. Although it itself is rarely fatal, the life expectancy of those affected is significantly reduced due to the often severe concomitant and secondary diseases. Chronic alcohol consumption, which is present in 80 percent of those affected, drastically reduces life expectancy.
Chronic pancreatitis – complications
Chronic pancreatitis is associated with tissue damage in the long term. This increases the risk of the following complications:
Pancreatic pseudocysts
Pancreatic pseudocysts often regress on their own within six weeks. In some cases, however, they become infected or rupture. If the patient suffers from discomfort, a surgeon usually surgically inserts a small tube through which the contents of the pseudocyst continuously drain.
Splenic vein and portal vein thromboses
Pancreatic cancer (pancreatic carcinoma)
As a late complication of chronic pancreatitis, pancreatic cancer sometimes develops at an advanced stage. People with hereditary pancreatitis and smokers are particularly at risk. It is therefore important to recognize and treat chronic pancreatitis at an early stage.
