Definition

Chronic pancreatitis is inflammation of the pancreas that worsens over time. The pancreas is an organ that sits behind the stomach. It makes fluids that help to break down food in the small intestine.

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Causes

There is often no known cause. In some people, it may be due to:

• Exposure to toxins, such as tobacco smoke, alcohol, and materials in some workplaces or the environment
• Injury
• A blockage, such as a tumor or gallstones
• Problems with the immune system

Risk Factors

This problem is more common in men and people who are Black. Other things that may raise the risk are:

• Alcohol use disorder
• Tobacco use disorder

Symptoms

The main problem is mild to severe pain in the upper belly. It may also spread to the back. Pain may be all the time or it may come and go.

Other problems may be:

• Pain that worsens when eating or drinking
• A swollen belly
• Nausea and vomiting
• Weight loss
• Loose, fatty, or oily stools

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.

Blood tests will be done to look for certain enzymes that point to chronic pancreatitis.

Images may be taken of the abdomen. This can be done with:

• Ultrasound
• CT scan
• Magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic retrograde cholangiopancreatography (ERCP)

A pancreatic function test may be done. This test measures how well the pancreas is making a hormone needed to digest food.

Treatment

The goal of treatment is to manage symptoms. Choices are:

• Supportive care, such as drinking extra fluids or getting fluids through an IV
• Dietary changes, such as a low fat diet or nutrition given through a tube that is passed through the nose and into the stomach
• Lifestyle changes, such as not drinking alcohol and not smoking
• Medicines, such as:
  • Pain relievers
  • Pancreatic enzymes to help with digestion
  • Corticosteroids to ease swelling

People who are not helped by these methods may need surgery. The type of surgery done depends on the reason for the pancreatitis. Some choices are:

• Percutaneous catheter drainage to drain fluid from the pancreas
• ERCP to open any blockages or drain cysts
• Cholecystectomy to remove the gallbladder
• Necrosectomy to remove dying or dead tissue from the pancreas

Prevention

The risk of this problem may be lowered by:

• Limiting alcohol
• Not smoking