CHRONIC PANCREATITIS IN ADULTS
Pancreatitis means inflammation of the pancreas. – when the inflammation is persistent. The inflammation tends to be less intense than acute pancreatitis but as it is ongoing it can cause scarring and damage. About 4 in 100 people across the world at any one time have chronic pancreatitis It is not known how many people in the Pakistan have this condition but it is thought to have increased considerably over the years. It is more common in men than women.
DIAGNOSIS OF CHRONIC PANCREATITIS
Unfortunately, there is currently no single test for chronic pancreatitis. Diagnosing chronic pancreatitis in its early stages is often difficult. Many pancreatic cells can be damaged before abnormalities show up on tests, X-rays or scans. The amount of enzymes made by the pancreas and the number of insulin-producing cells can become quite low before any symptoms of poor digestion or diabetes develop. Once the damage and scarring to the pancreas is more severe, or when calcium stones start to form, then the damaged pancreas can be detected by X-rays or scans. However, by this time the malabsorption or symptoms of diabetes may have already developed.
Tests done usually include:
- Blood tests to check your blood count, kidney and liver function.
- Blood tested for diabetes.
- Your doctor may also request a sample of your faeces (poo, stools or motions) for testing.
- An X-ray or CT scan of your tummy (abdomen) may be performed.
- A cholangiogram is a test which produces a picture of the bile ducts. This is often done using an MRI scan.
- Looking at the pancreas with a telescope put down into your stomach. Occasionally, dye is squirted up the tube leading to the pancreas (the pancreatic duct) to obtain a clearer picture of what is going on.
What complications can develop? Most people with chronic pancreatitis do not have complications. However, the following may occur:
- Pseudocyst – develops in about 1 in 4 people with chronic pancreatitis. This is when pancreatic fluid, rich in chemicals (enzymes), collects into a cyst due to a blocked tube which leads to the pancreas (the pancreatic duct). These can swell to various sizes. They may cause symptoms such as worsening pain, feeling sick and vomiting. Sometimes they go away without treatment. Sometimes they need to be drained or surgically removed.
- Ascites – sometimes occurs. This is fluid that collects in the tummy (abdominal) cavity between the organs and guts (intestines).
- Blockage of the bile duct – is an uncommon complication. This causes jaundice as bile cannot get into the gut and leaks into the bloodstream. This makes your skin look yellow.
- Cancer of the pancreas – is more common than average in people with chronic pancreatitis. The risk increases in smokers and with increasing age
- Rare complications – include blockage of the gut, bleeding or blood clot (thrombosis) in blood vessels near to the pancreas.
It is fairly common to feel low when you have chronic pancreatitis, especially if you are in pain. Some people even become depressed, which can respond well to treatment. It is important to talk to your doctor about any symptoms of depression you may have.
TREATMENT FRO CHRONIC PANCREATITIS:
- Stop drinking alcohol for good – this is the most essential part of treatment. You should not drink alcohol even if it is not the cause of your chronic pancreatitis.
- Painkillers – are usually needed to ease the pain. Controlling the pain sometimes becomes quite difficult and referral to a pain clinic may be needed. Apart from painkillers, other techniques to block the pain may be considered, such as nerve blocks to the pancreas.
- Enzyme replacement medication – may be needed if the low level of chemicals (enzymes) causes poor digestion of food and steatorrhoea. Capsules containing artificial enzymes are taken with meals.
- Restricting fat in the diet – may be advised if steatorrhoea is bad.
- Insulin – if diabetes develops then insulin injections will be needed to control the blood sugar level.
- Vitamins – may need to be taken.
- Do not smoke – to minimise the risk of pancreatic cancer developing.
If you have autoimmune pancreatitis then you may be given a course of steroid tablets.
Surgery -Most people with chronic pancreatitis do not need surgery but an operation is sometimes needed. The common reason for surgery is for persistent bad pain that is not helped by painkillers or other methods. Improvement in pain occurs in about 7 in 10 patients who have surgery. The operation usually involves removing part of the pancreas. There are different techniques that remove different amounts of the pancreas. The one chosen depends on the severity of your condition, whether the pancreatic duct is blocked, and also on various other factors. Other operations may be advised in some cases – for example, removal of a large calcium stone that is blocking the main pancreatic duct. Another procedure that may help in some people is to ‘stretch’ wide a narrowed pancreatic duct to allow better drainage of pancreatic enzymes. Surgery may also be needed if a complication develops. For example, if a blocked bile duct or pseudocyst develops. If the pain is persistent you may be offered a procedure to block the nerve supply to the area. Examples of treatments which involve this approach are coeliac plexus block and spinal cord stimulation. If you need surgery, then your surgeon will be able to discuss with you in detail the type of operation you need.
OUTLOOK FOR CHRONIC PANCREATITIS:
If alcohol is the cause of chronic pancreatitis then other alcohol-related illnesses also commonly develop. If you continue to drink alcohol and pancreatitis becomes severe than life expectancy is typically reduced by 10-20 years. This is due to complications of pancreatitis or to other alcohol related illnesses. If you stop drinking alcohol completely in the early stages of the condition, the outlook is better. The outlook for other less common causes of chronic pancreatitis depends on the cause and severity of the condition.