Chronic pancreatitis

What is chronic pancreatitis? 

Chronic pancreatitis refers to an inflammation of the pancreas lasting over a long period of time. Generally, to be considered chronic, it must persist for at least six months.   

The pancreas is composed of two different components that serve different functions.  

The majority of the tissue is called the exocrine pancreas. Here, several digestive enzymes are being produced, which then are passed through the pancreatic duct into the small intestine. These digestive enzymes can then aid in the absorption of fats from food, for example.  

The so-called endocrine pancreas produces important hormones. These cells are dispersed among the glandular cells of the exocrine pancreas. They account for only a small proportion of the organ's bulk, but fulfill very important functions. The major hormones produced are insulin and glucagon, which work together to control blood sugar levels.  

Because the cells are scattered across the organ like islands, we also call these clusters of cells the islets of Langerhans.  

As chronic pancreatitis progresses, both exocrine and endocrine function are compromised.  

Causes: How does chronic pancreatitis develop? 

Chronic inflammation of the pancreas may have various underlying causes.  

Approximately 70-80% of all cases involve chronic alcohol abuse as the cause of pancreatitis. Although it is still unclear just exactly how alcohol damages the pancreatic cells, evidence has shown that the consumption of alcohol can generally induce inflammatory reactions. The increased production of connective tissue together with the loss of healthy organ cells is also favored by alcohol.  

Both of these processes take place in the setting of chronic pancreatitis.  

Often, there is no identifiable cause for the inflammation. Medically, this is referred to as idiopathic pancreatitis. Several studies have been able to identify genetic factors associated with this condition, although their exact role has not yet been definitively determined.  

There are certain substances which can irritate the pancreatic tissue and thereby promote inflammation. Among these are nicotine in particular, but also medications that are taken over a long period of time.  

Other potential reasons for this condition are increased levels of free fatty acids or calcium in the blood as well as autoimmune processes. Both free fatty acids and calcium stimulate the pancreas to produce large amounts of digestive enzymes, which in turn can damage organ tissue in the long term.  

Autoimmune disorders involve the unfavorable production of antibodies against structures of your own body, which attack the tissue. In this case, an attack is mounted against cells of the pancreas.

Symptoms & complaints of chronic pancreatitis 

Chronic pancreatitis frequently follows acute inflammation and nearly always causes pain. Usually, other symptoms are present as well.  

The specific pain associated with chronic pancreatitis is recurrent, usually for a few hours to days, around the upper abdomen. The pain is made worse by pressure and can also radiate down the back in a belt-like fashion. Only when the disease is far advanced will patients no longer complain of pain.  

As the pancreas plays an important role in digestion, any inflammation is noticeable in this field. In particular, fats usually can't be digested well. As a result, patients experience pain, especially after a meal.  

Many patients subsequently avoid eating, resulting in weight loss. Moreover, patients often present with flatulence, diarrhea, and fatty stools.   

The endocrine function of the pancreas, that is, the production of hormones, is generally only impaired when the disease is already very advanced. Approximately one third of all patients in the late stages of chronic pancreatitis develop diabetes mellitus as a result of the lack of insulin.

Diagnosis of chronic pancreatitis 

The first step in diagnosis is to obtain a patient's medical history and perform a physical examination, which is followed by a number of clinical tests and imaging procedures.  

During the interview, the doctor will ask the patient about his or her exact symptoms. Based on the symptoms, there are usually first clues to the disease. In addition, possible risk factors, such as increased alcohol consumption, smoking or family history of the disease, are investigated.  

Palpation of the upper abdomen mostly shows a pressure pain in the left upper abdomen, raising the suspicion of pancreatitis.  

Currently, the most common clinical test to diagnose pancreatitis is the determination of digestive enzymes in the patient's stool. Most importantly, the enzyme pancreatic elastase-1 is examined.  

imaging techniques can provide clues regarding the extent of the disease. In order to detect potential calcifications or abnormalities of the pancreatic ducts, classic sonography (ultrasound examination) and endosonography are the most suitable methods.  

Endosonography involves inserting a so-called endoscope through the mouth directly into the organ of interest, in this case the pancreas. An endoscope is a flexible tube equipped with a small camera and an ultrasound probe.  

In most cases, a special type of endoscopy is performed, called ERCP. Endoscopic retrograde cholangiopancreatography provides a radiological assessment of both bile ducts and pancreas.   

Some cases also make use of procedures like computed tomography (CT), magnetic resonance imaging (MRI), or genetic testing.  

Therapy & treatment of chronic pancreatitis 

There are several treatment options, according to the cause of pancreatitis.  

Strict abstinence from alcohol and nicotine have the highest priority in therapy. 

Once a triggering factor for chronic pancreatitis has been determined, the priority is to address it. If alcohol addiction is present, for example, withdrawal therapy needs to be provided to alleviate the symptoms. It is generally advisable to prohibit smoking, although nicotine alone is not considered to be the trigger. 

Moreover, symptomatic therapy is provided to substitute the lost function of the pancreas. Concerning the exocrine pancreas, dietary changes are recommended as well as supplying the missing digestive enzymes with medication.  

If the endocrine function of the pancreas is already compromised, the blood sugar level has to be strictly controlled and external insulin has to be supplied.  

As patients usually complain about pain in the upper abdomen, pain medication is prescribed as needed. In cases where constrictions are found in the pancreatic ducts, surgery is performed to widen the ducts, which brings relief to many patients.    

Life expectancy & prognosis in chronic pancreatitis 

There is no total cure for chronic pancreatitis, but treatment can relieve symptoms and result in partial tissue regeneration.  

Studies have shown that the 10-year survival rate of patients with chronic pancreatitis is about 70%.  

The overall life expectancy of patients with chronic pancreatitis is also reduced because most patients have a number of coexisting diseases, that in turn reduce life expectancy. Additionally, chronic inflammation raises the risk of pancreatic cancer.

Diet for chronic pancreatitis 

Apart from a consistent avoidance of alcohol and nicotine, a dietary change is among the key factors of the therapy.  

A diet rich in carbohydrates with about 5-7 smaller meals is recommended. According to the remaining function of the pancreas, the amount of fat in the diet should also be reduced. Especially medium-length fatty acids should be consumed.  

To alleviate the symptoms of chronic pancreatitis through optimized nutrition, it is recommended to undergo nutritional counseling. First of all, the patient's individual dietary requirements as well as the current level of enzyme production can be established. Afterwards, a nutrition plan can be created.

Which doctors & clinics specialize in chronic pancreatitis? 

Chronic pancreatitis needs continuous treatment over a long period of time. To achieve this, a relationship of trust between doctor and patient is crucial.  

This is why patients wish to be treated by a specialist offering a high level of expertise.  

Our aim is to help you find the right doctor, so we have carefully selected all of the physicians presented here. You can trust in our experts' experience and arrange an initial consultation appointment in a fast and uncomplicated way.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of chronic pancreatitis and are looking forward to your inquiry or wish for treatment.

Sources:   

• Amboss, Nachschlagewerk für Mediziner   
• next.amboss.com/de/article/hS0cz2;
• Herold, Gerd. Innere Medizin 2017, Berlin, Boston: De Gruyter, 2017