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Chronic pancreatitis

Published by Bupa's health information team, May 2008.

This factsheet is for people with chronic pancreatitis, or who would like information about it.

Chronic pancreatitis is when your pancreas is irreversibly damaged - this stops it functioning properly. You will need to take medicines for the rest of your life to help you digest food, and to maintain your blood sugar levels if they are affected.

• About chronic pancreatitis
• Symptoms
• Causes
• Diagnosis
• Treatment
• Prevention
• Further information
• Questions and answers
• Related topics
• Sources

About chronic pancreatitis

Your pancreas is a 15 centimetres (six inches) long organ which is part of your digestive system. It's found just in front of your spine (back bone), behind your stomach, at the level where the two sides of your rib cage join together. It's connected to the duodenum (small bowel) by a tube called the pancreatic duct.

Your pancreas produces enzymes (digestive juices) which break down food, particularly fatty foods. These digestive juices pass down the pancreatic duct into the duodenum which contains food to be digested. The pancreas also produces insulin - a hormone that helps to keep the level of sugar in your blood constant.

In the UK, between 40 and 75 in every 100,000 people get chronic pancreatitis each year. It mainly affects men between 40 and 50.

Symptoms

There are a number of symptoms of chronic pancreatitis, including:

• persistent or recurrent pain around the upper part of your abdomen (tummy) and/or back which may be better when you sit forwards
• vomiting
• feeling weak
• jaundice, which is when the whites of your eyes and your skin look yellowed
• pale, fatty, smelly faeces that are difficult to flush away
• unexplained weight loss
• thirst and passing large amounts of urine (diabetes)
• long-term health problems

Although not always a sign of chronic pancreatitis, if you experience these symptoms, you should seek medical advice.

Complications

Complications can include:

• benign growths called cysts which can grow in the pancreas - if they grow too large you may need an operation to drain them
• bleeding
• inflammation of the gallbladder
• addiction to pain relief medicines
• diabetes
• slight increased risk of developing pancreatic cancer

Please see Related topics for information on pancreatic cancer.

Causes

Chronic pancreatitis is caused by alcohol in seven out of 10 people - this is usually due to excessive drinking over 10 years or more.

Other causes include:

• genetics - you may inherit a faulty gene from your parents, this type of chronic pancreatitis is called hereditary chronic pancreatitis
• cystic fibrosis
• haemochromatosis - a rare genetic disease which is caused by too much iron in the body
• obstruction of the pancreatic duct - caused by gallstones or cancer
• pancreas divisum - this is when you are born with ducts which do not function properly
• lack of nutrients or eating too much of the plant cassava root - this is particularly linked to people in developing countries

Please see Related topics for information on cystic fibrosis and gallstones.

Diagnosis

Your GP will examine you and ask you about your symptoms. They may take a blood test and refer you to a gastroenterologist, a doctor who specialises in conditions of the digestive system, for tests which may include the following.

• Further blood tests may be taken which will be sent to a laboratory for testing.
A faeces sample test may be required. This will be sent to a laboratory for testing.
• You may have an abdominal ultrasound which uses high frequency sound waves to produce an image to look for any changes. This is sometimes done using an endoscope.
• A biopsy may be taken from the pancreas with a needle. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing.
• An ERCP (endoscopic retrograde cholangio-pancreatography) is a test where a narrow, flexible, tube-like telescopic camera called an endoscope is guided using ultrasound, to check your digestive system. This procedure can also occasionally trigger an attack of pancreatitis.

Please see Related topics for information.

Treatment

You should stop drinking alcohol, especially if your chronic pancreatitis is caused by alcohol.

You may be advised to avoid large meals which contain a large amount of fat. You may be referred to a dietician who will usually recommend a diet that is low-fat, high-protein and high in calories. If you are taking pancreatic enzyme medicines you may not need to do this. Ask your doctor for advice.

You may need to take vitamin supplements if you have not been getting enough vitamins in your diet.

Medicines

Pain relief medicines, such as tramadol (eg Zamadol, Zydol), may be used but they are not suitable for everyone due to some of the side-effects. Some doctors may prescribe tricyclic antidepressants, such as amitriptyline, which are used for chronic pain but this treatment is unlicensed. Nerve blocks are also sometimes used but how effective they are is unclear. This is when your nerves, which allow you to feel pain, are injected with a local anaesthetic.

You may need to take pancreatic enzyme supplements such as pancreatin (eg Creon, Nutrizym, Pancrex) to replace the enzymes the pancreas can no longer make. They are usually taken before, during or straight after meals. Side-effects can include feeling sick, vomiting and discomfort in the abdomen. These medicines can't be taken by children aged 15 or less with cystic fibrosis.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Surgery

If you have severe pain you may need to have an operation. This may be to ensure the duct is draining the digestive juices properly or to remove part of the pancreas and/or part of the small bowel. If you need surgery your doctor will discuss this with you.

Chronic pancreatitis caused by gallstones

Gallstones are solid lumps or stones that form in the gallbladder or bile duct. You may need to have gallstones or your gallbladder removed during your treatment for chronic pancreatitis. This will involve either an operation (open or keyhole surgery) or an ERCP (see Diagnosis).

Treatment for diabetes

You may develop diabetes if you have chronic pancreatitis. If your pancreas is no longer producing insulin, which regulates the level of sugar in your blood, you will need to give yourself daily injections of insulin and learn how to manage your diabetes.

Please see Related topics for information.

Prevention

Chronic pancreatitis can be prevented by eating a healthy diet, not eating the plant cassava root and avoiding alcohol.

Further information

• The Pancreatitis Supporters' Network
  www.pancreatitis.org.uk
• CORE charity
  www.digestivedisorders.org.uk

Related topics

• Acute pancreatitis
• Cystic fibrosis
• Diabetes type 1
• Gallstones
• Overactive thyroid
• Pancreatic cancer
• Abdominal ultrasound

Sources

• Bornman PC, Beckingham IJ. Chronic pancreatitis. BMJ. 2001.322. 660-663
• British National Formulary (BNF) September 2007. BMJ Publishing Group, 2007 54:67-68
• Chronic pancreatitis. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, accessed 15 November 2007
• Kumar, P and Clark, M, Clinical medicine. 6th ed. London: Elsevier Saunders, 2005. 411-414
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford:Oxford University Press. 2005:448-449
• Singer M, Webb AR. Oxford Handbook of Critical Care. 2nd ed. Oxford:Oxford University Press. 2005:354-355
• The pancreas and pancreatitis. CORE charity. www.digestivedisorders.org.uk, accessed 12 November 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr John E Smithson MD FRCP, Consultant Gastroenterologist at Bristol Royal Infirmary, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2008.