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Chronic pancreatitis frequently asked questions – Chronic Pancreatitis

Chronic pancreatitis is a continuing inflammatory process of the pancreas. It causes irreversible morphologic changes with many complications.

Although chronic pancreatitis (CP) is not a very common disease, it accounts for up to 56.000 hospitalizations every year only in the US. On the other side, up to 122.000 patients visit their doctor every year with this diagnosis.

In the following article, a doctor will explain all you need to know about chronic pancreatitis in simple terms. Frequently asked questions like if you can drink alcohol with CP or is it curable, will all be answered. We will also review the basics of the condition, like the causes, symptoms, complications, and treatment. So keep reading, and learn a little more about this disease. 

What is the pancreas?

The pancreas is an organ of your digestive system. Its location is in the center of your upper abdomen, right behind your stomach. It has three main portions: the head, the body, and the tail. This is a long organ with a lobulated appearance. 

File:Blausen 0699 PancreasAnatomy2.png
Pancreas Anatomy
Source

The pancreas is a gland; therefore, it produces and releases substances and fluids to other parts of your body. It has two main functions: an endocrine and an exocrine function.

The endocrine function is to produce and release hormones that regulate blood sugar levels, like insulin and glucagon. On the other side, the exocrine function is basically to secrete pancreatic fluid into the first portion of the small intestine.

The pancreatic fluid is released to the small intestine through the main pancreatic duct. This pancreatic secretion contains digestive enzymes that break down the carbs, fats, and proteins we eat. Also, it has bicarbonate to neutralize the acid coming from your stomach into the small intestine. On a regular day, the pancreas can produce from 1.5 to 3 liters of pancreatic fluid.

What is chronic pancreatitis? 

Chronic pancreatitis is an ailment in which there is a continuing inflammatory process of the pancreas. This results in irreversible changes in the structure of the pancreas.

This disease can present itself as acute inflammation episodes in an injured pancreas or as progressive damage. Sometimes, chronic pancreatitis can cause pancreatic calcifications or cysts that block the pancreatic duct. This makes it hard to release the pancreatic juice, impeding proper food digestion. Also, damage to the pancreatic parenchyma (its tissue) may result in dysregulations in blood sugar levels. 

In the early stages of chronic pancreatitis, you may not notice any symptoms. The most common symptom in CP patients is pain in the upper abdomen. Additionally, there could be diarrhea and/or change in your stools’ characteristics. Stools may be pale and fatty looking, and they will float on the toilet, making them harder to flush.

Other symptoms include weight loss, even with the usual diet, nausea, vomiting, excessive thirst, and fatigue. These symptoms result from malabsorption of nutrients and poor utilization of blood sugar to nourish your body cells.

As we said before, the most common symptom is abdominal pain, which can last from hours to days. In fact, some chronic pancreatitis patients experience constant, chronic pain. 

What happens in chronic pancreatitis?

Chronic pancreatitis is the result of a persistent inflammatory reaction. Whatever the cause is, the main reason for this condition is inflammation.

As a result of acute damage, an inflammatory response starts, releasing all kinds of pro-inflammatory substances. These substances are signals for the inflammatory cells like white blood cells that a reaction is happening.

When the white cells arrive at the site of the inflammation, they produce more pro-inflammatory substances. When inflammatory reactions persist, the production of other types of proteins begins. These proteins are collagen and fibronectin, which turn the inflamed tissue into fibrotic tissue.

This fibrotic tissue is like a scar in the pancreas. This part of fibrotic tissue is unable to perform the normal functions of the pancreas. If the inflammatory reaction continues, the fibrotic tissue will take up more and more space.

Moreover, due to inflammation, pseudocysts may appear. These are little bags of tissue with liquid on the inside, which do not have a normal function. Finally, the accumulation of pancreatic fluids with digestive enzymes can digest the pancreas itself, destroying the remaining healthy tissue or parenchyma.

Additionally, the collection of fluids can cause calcifications in the pancreas, causing obstructions in the pancreatic and common bile duct. This perpetuates the pancreatic fluid buildup, making the digestion of the pancreas worse. 

How common is chronic pancreatitis?

Thankfully, chronic pancreatitis is not that common. In the world, there is an estimate of 5 to 12 new cases in 100.000 people every year.

In industrialized countries, the estimation of people with chronic pancreatitis is 40 in 100.000 people annually. It can affect both men and women, being most common in men. People are most likely to develop chronic pancreatitis between their thirty and sixty years, although most diagnoses are made between fifty and sixty.

What is the difference between acute pancreatitis and chronic pancreatitis?

Acute pancreatitis is a sudden, short episode of inflammation occurring in the pancreas. On the other side, chronic pancreatitis is an on-going, persistent inflammation of the pancreas. This persistent inflammation causes tissue damage and can make it change to fibrotic, hence, non-functioning tissue.

Symptoms are different between the two of them. In the case of acute pancreatitis, the pain is sudden, and so severe it may get you to the ER. The patient may present vomits and fever accompanying the abdominal pain. In the case of chronic pancreatitis, the pain can be mild, episodic, or continual. Sometimes the patient will only have abdominal pain after meals, making the diagnosis harder and later. 

Besides, the causes of these two forms of pancreatitis vary widely. For acute pancreatitis, the most common cause is obstruction caused by gallstones. For chronic pancreatitis, the most common cause is chronic alcoholism. However, sometimes the damage resulting from acute pancreatitis can lead to chronic pancreatitis in the future. But, this will depend on how severe and where the damage happened. 

What are the causes of chronic pancreatitis? 

There exact cause of chronic pancreatitis is still unknown. However, many risk factors can cause chronic pancreatitis. Some of them are as follows.

  • Alcoholism: it is present in most chronic pancreatitis patients and is the most common cause of CP. 
  • Autoimmune pancreatitis: as other autoimmune diseases, your immune system attacks healthy cells of your body. In this case, your immune system attacks the cells of your pancreas, causing inflammation. 
  • Obstruction: another common cause for chronic pancreatitis is obstruction of the pancreatic duct. When an obstruction exists, the pancreatic fluid builds up inside your pancreas. This causes an inflammatory reaction because of the digestive enzymes in the fluid.
  • Tumors: these are less common, but tumors damage the pancreatic tissue, resulting in chronic pancreatitis. 
  • Idiopathic pancreatitis: when there is no identifiable cause, chronic pancreatitis will be considered idiopathic.
  • Hereditary pancreatitis.

Other causes of chronic pancreatitis include genetic and hereditary factors. Also, further conditions like cystic fibrosis represent a big risk for developing chronic pancreatitis. This happens because, in cystic fibrosis, the fluids in your body become thicker.

In the case of the pancreas, when the pancreatic fluid becomes more viscous, it’s harder for it to exit through the pancreatic duct. The result is a fluid buildup inside the pancreas, causing pancreatitis. 

Who is at risk for chronic pancreatitis?

As we mentioned before, chronic pancreatitis affects both men and women, although the former are more likely to develop CP. Additionally, chronic pancreatitis is more likely to occur between thirty and sixty years.

Other groups of people at risk include those with alcoholism. Alcoholic chronic pancreatitis is the most common form of chronic pancreatitis. Patients with autoimmune diseases and tumors are also at risk of developing CP. 

Another group of patients is at risk because of a genetic predisposition for chronic pancreatitis. This group includes patients with genetic mutations related to cystic fibrosis, even if they don’t have the disease. Also, there is a hereditary factor for chronic pancreatitis. If you have two or more people in your immediate family with CP, you have a greater chance of developing chronic pancreatitis. 

Additionally, patients with stones in the bile duct may also develop pancreatitis. This is because of the ducts’ blockage that get both the bile and the pancreatic fluid to the intestine.

There is also a procedure called endoscopic retrograde cholangiopancreatography (ERCP) to treat bile obstructions without surgery. One of the side effects of this procedure could be pancreatitis, although in a minor percentage of the cases. 

What are the complications of chronic pancreatitis?

If you don’t receive treatment for chronic pancreatitis, you may end up with many complications. The loss of pancreatic function due to CP results in pancreatic insufficiency.

When the pancreas doesn’t function properly, there are two main functions in your body altered. These are the digestion and absorption of nutrients and the regulation of blood sugar. 

The exocrine insufficiency results in malabsorption and even malnutrition. This happens because the pancreas produces fluid that contains digestive enzymes. These digestive enzymes break down the food we eat into fats, proteins, and carbs, so our body absorbs them. When the pancreas doesn’t work well, the nutrients aren’t digested or absorbed; doctors call it malabsorption. If malabsorption continues, the patient will have malnutrition. 

On the other side, when the damage of the pancreatic tissue occurs, you may have endocrine insufficiency too. This happens because the pancreas cells produce hormones like insulin and glucagon, which are responsible for blood sugar regulation. When these cells die, they stop producing these hormones. This is why; almost half of all the patients with chronic pancreatitis will develop diabetes mellitus if not treated. 

Another common complication of chronic pancreatitis is the formation of a pseudocyst or pseudocysts. These are growths of tissue that fill up with liquid. They can appear in the pancreatic tissue or their surroundings. This also affects the pancreatic function because pseudocysts can block essential blood vessels and ducts.

These patients would also have a 4% risk of developing pancreatic cancer in twenty years.  

How is chronic pancreatitis diagnosed?

First, like in any other condition, your doctor will ask questions about your medical history. Also, they will ask questions about your habits, like drinking alcohol and smoking.

Then, they will begin to ask questions about the symptoms you’ve been experiencing. If your doctor suspects you have chronic pancreatitis, they will indicate some studies.

In the early stage of the disease, blood tests may not be very useful. However, there are blood tests that are pancreatic function tests. They measure the number of pancreatic enzymes like amylase and lipase in your blood.

Another useful test is a stool sample test. With this test, doctors can determine if you have fatty stools due to pancreatitis. 

However, the best tests to diagnose chronic pancreatitis are imaging tests. Between the imaging tests, a doctor may indicate there are: X-rays, abdominal ultrasounds, CT scans, or MRIs.

Another great diagnostic test is endoscopic ultrasound. It works just like a regular ultrasound, but your doctor will introduce the probe from your mouth to your stomach. This method gives a better look at the pancreas and will determine if you have pancreatic ductal obstruction.  

How is chronic pancreatitis treated?

Keep in mind that this is a chronic condition. Sadly, no treatment can undo the damages to the pancreas. Nevertheless, there are medical treatments available to improve your symptoms.

The typical medications for chronic pancreatitis include:

  • Pain medications: to stop or help with abdominal pain.
  • Digestive enzymes supplements: if your levels are low, digestive enzymes’ supplements will be a great tool to help with your digestion. This way, you avoid malabsorption. 
  • Insulin: if you develop diabetes as a result of chronic pancreatitis, you will need insulin. This is because your pancreas is no longer producing it. 

Depending on the cause, you may need other medications. For example, if you have autoimmune pancreatitis, your doctor will probably prescribe steroids to treat this condition. 

Some procedures can help in the treatment of chronic pancreatitis too. There are endoscopic procedures in which doctors insert an endoscope through your mouth. This way, they can remove blockages of stones or dilate conducts with stents. 

Sometimes patients may experience severe pain that doesn’t get better with medication. In these cases, surgery may be an option. By doing a pancreatic resection (removing a portion of the pancreas), doctors may provide relief for severe pancreatitis—usually, the preferred portion for pancreatic resection in the pancreatic head.  

Can alcoholic pancreatitis be cured?

Not really. Remember that this is a chronic condition. This means that no matter the cause, it is not reversible or curable. The damage the pancreas has can’t be reverted; still, as we mentioned before, with the medication, you can find symptom relief and stop the condition’s progression.

In the case of alcoholic pancreatitis, the most important treatment is to stop drinking alcohol. This way, you can stop CP from progressing into one of the many complications it has. 

Can you stop the progression of chronic pancreatitis?

Not quite. Even with all the right measures, you won’t entirely stop the progression of chronic pancreatitis. Still, if you have healthy habits, you can slow down its progression. Besides, you will prevent further damage in your pancreas, preventing complications.

The management of chronic pancreatitis is not easy, but it can change your life if you do it right. Even if it doesn’t stop the progression of the disease, it is really worth it. Also, you can prevent acute attacks or exacerbations of pancreatitis with healthy habits and treatment. 

Can you drink alcohol with chronic pancreatitis?

Absolutely not. Alcohol is the most frequent cause of chronic pancreatitis. By drinking, you will only make the condition worse. Even if alcoholism is not the cause in your case, alcohol should be avoided from the moment chronic pancreatitis is diagnosed.

Keep in mind that you can’t get rid of chronic pancreatitis. The only thing you can do is slow down its progression so it doesn’t worsen. Additionally, alcoholism is not a healthy habit.

Alcohol can cause damage to many organs in your body, like the liver and the brain. In fact, alcoholism itself can damage the intestine and cause poor absorption of nutrients. If you combine that with the malabsorption caused by chronic pancreatitis, you have the recipe for malnutrition. So, as advice for your overall health, stop drinking. 

Can you live with chronic pancreatitis?

Yes. In fact, sometimes, people with chronic pancreatitis won’t even have symptoms in the early stages of the disease. However, without treatment, patients will probably not live as long as they could. They may also not live a normal life since they are not getting all the nutrients they need. CP, most of the time, is not a life-threatening condition, but it will require treatment and follow-up. 

Not all cases of chronic pancreatitis are the same. Some cases could be milder than others, and some cases could be so severe that they’ll need surgery. The severity of the damage to the pancreas is related to the condition causing the CP.

The medical treatment for chronic pancreatitis will ensure that you live a life as normal as possible. The key to the treatment is to prevent further damage or complications. You will most likely spend the rest of your life with pancreatic enzyme supplements. Besides, your doctor will forbid you from drinking alcohol since it can may the condition worse, although this is only a small price to pay to live a happy and healthy life.

Approximately two-thirds and a half of the patients with chronic pancreatitis will live more than ten and twenty years, respectively. Considering that this disease is usually diagnosed in people in their late adulthood, these are not bad numbers at all.

What happens if you leave pancreatitis untreated?

If you leave chronic pancreatitis untreated, there is a high risk of developing its complications. As we mentioned before, chronic pancreatitis can lead to malnutrition and diabetes.

When you don’t receive treatment, your body is incapable of digesting nutrients like fats, proteins, and carbs. This way, even if you eat, your body won’t absorb the nutrients it needs. Without treatment, a person can develop malnutrition pretty fast, depending on the case.

Also, when the pancreatic damage is extensive, you will develop diabetes pretty fast, too. This is the result of the destruction of pancreatic cells that produce insulin.

Persisting inflammation can also lead to liquid buildup around the pancreas; it is known as pancreatic ascites. Also, suppose the inflammation persists for a long time. In that case, the pancreas can be completely destroyed. Pseudocysts can take up all of the pancreatic’s parenchyma or tissue. These pseudocysts can become infected and cause a more severe intraabdominal infection as it is peritonitis.

Do you have symptoms of this disease?

This is a Chronic Pancreatitis Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, this tool will tell anybody who uses it the likelihood of their symptoms because of chronic pancreatitis. Using this tool is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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