Home > Health A – Z > Chronic Pancreatitis

Chronic Pancreatitis

Inflammation of the pancreas. Chronic pancreatitis may cause diabetes and problems with digestion. Pain is the primary symptom.

PubMed Health Glossary
(Source: NIH - National Cancer Institute)

About Chronic Pancreatitis

Chronic pancreatitis is inflammation of the pancreas that does not heal or improve—it gets worse over time and leads to permanent damage. Chronic pancreatitis, like acute pancreatitis, occurs when digestive enzymes attack the pancreas and nearby tissues, causing episodes of pain. Chronic pancreatitis often develops in people who are between the ages of 30 and 40.

The most common cause of chronic pancreatitis is many years of heavy alcohol use. The chronic form of pancreatitis can be triggered by one acute attack that damages the pancreatic duct. The damaged duct causes the pancreas to become inflamed. Scar tissue develops and the pancreas is slowly destroyed.

Other causes of chronic pancreatitis are

  • hereditary disorders of the pancreas
  • cystic fibrosis—the most common inherited disorder leading to chronic pancreatitis
  • hypercalcemia—high levels of calcium in the blood
  • hyperlipidemia or hypertriglyceridemia—high levels of blood fats
  • some medicines
  • certain autoimmune conditions
  • unknown causes

Hereditary pancreatitis can present in a person younger than age 30, but it might not be diagnosed for several years. Episodes of abdominal pain and diarrhea lasting several days come and go over time and can progress to chronic pancreatitis. A diagnosis of hereditary pancreatitis is likely if the person has two or more family members with pancreatitis in more than one generation. NIH - National Institute of Diabetes and Digestive and Kidney Diseases

What works? Research summarized

Evidence reviews

Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications [Internet]

Alcohol is the most widely used psychotropic drug in the industrialised world; it has been used for thousands of years as a social lubricant and anxiolytic. In the UK, it is estimated that 24% of adult men and 13% of adult women drink in a hazardous or harmful way. Levels of hazardous and harmful drinking are lowest in the central and eastern regions of England (21–24% of men and 10–14% of women). They are highest in the north (26–28% of men, 16–18% of women). Hazardous and harmful drinking are commonly encountered amongst hospital attendees; 12% of emergency department attendances are directly related to alcohol whilst 20% of patients admitted to hospital for illnesses unrelated to alcohol are drinking at potentially hazardous levels. Continued hazardous and harmful drinking can result in dependence and tolerance with the consequence that an abrupt reduction in intake might result in development of a withdrawal syndrome. In addition, persistent drinking at hazardous and harmful levels can also result in damage to almost every organ or system of the body. Alcohol-attributable conditions include liver damage, pancreatitis and the Wernicke’s encephalopathy. Key areas in the investigation and management of these conditions are covered in this guideline.

Pancreatic enzymes for chronic pancreatitis

Chronic pancreatitis is a condition afflicting nearly 0.04% to 5% of the population worldwide. The disease presents as recurrent episodes of abdominal pain, fatty stools and weight loss, or may be asymptomatic. Patients may develop complications over a variable period of time. Medical treatment often involves prescription of pancreatic enzyme preparations for these patients. This practice is based on studies which have shown the benefit of pancreatic enzymes on various outcomes such as abdominal pain, weight loss, analgesic use, fatty stools and quality of life. However, a collective conclusion about the role of pancreatic enzymes in chronic pancreatitis patients needs to be established from these studies. This systematic review aimed to collect all published and unpublished data on this subject in order to evaluate whether pancreatic enzymes have any benefit on various parameters in chronic pancreatitis, to compare different types of enzyme preparations and to evaluate whether different dosage schedules have any influence on the various outcomes. We included 10 studies in the review. These studies had enrolled small numbers of patients. Though individual studies showed benefit of varying degrees on the parameters mentioned above, we could not pool the results of these studies. With the evidence available so far, no definitive conclusion can be drawn for the benefit of pancreatic enzymes in patients with chronic pancreatitis.

Antioxidants to reduce pain in chronic pancreatitis

Chronic pancreatitis is a persistent inflammation of the pancreas that in the long run can cause irreparable damage. The major causes of chronic pancreatitis are genetics, alcohol toxicity and other conditions that might damage or obstruct the pancreas. This inflammation can cause pain that often is severe and leaves patients socially isolated and unable to perform their jobs. Unfortunately, treatment options are scarce, and often strong morphine‐like pain medications are needed. Patients might benefit from alternative medication without the adverse effects associated with morphine‐like medication. This review summarises the evidence from randomised trials on the effects of antioxidants in chronic pancreatitis. Antioxidants are substances that prevent damage to cells caused by toxic byproducts of oxygen in the body. Levels of these byproducts are increased in chronic pancreatitis. Antioxidants constitute a large group that contains many natural and man‐made products. Examples include vitamin C, vitamin E, flavonoids (present in tea and cocoa) and many specialised medications. We found 12 randomised trials on this topic. The quality of these trials was mixed, and many had small sample sizes and high rates of dropout. Evidence shows that antioxidants may reduce pain in patients with chronic pancreatitis, but the reported reduction in pain was small. Whether this small decrease really had an impact on patients' complaints is not clear. Given the methodological problems of these trials, a strong conclusion could not be drawn. Use of antioxidants resulted in adverse effects in about 16% of study participants. Most adverse effects were mild, such as headache, nausea and constipation. However, participants who developed these adverse effects tended to stop using antioxidant medication. Other outcomes important for decision making such as use of analgesics, rate of exacerbation of pancreatitis and quality of life, were not very well reported. Therefore, we were unable to reach conclusions on these outcomes.

See all (120)

Summaries for consumers

Pancreatic enzymes for chronic pancreatitis

Chronic pancreatitis is a condition afflicting nearly 0.04% to 5% of the population worldwide. The disease presents as recurrent episodes of abdominal pain, fatty stools and weight loss, or may be asymptomatic. Patients may develop complications over a variable period of time. Medical treatment often involves prescription of pancreatic enzyme preparations for these patients. This practice is based on studies which have shown the benefit of pancreatic enzymes on various outcomes such as abdominal pain, weight loss, analgesic use, fatty stools and quality of life. However, a collective conclusion about the role of pancreatic enzymes in chronic pancreatitis patients needs to be established from these studies. This systematic review aimed to collect all published and unpublished data on this subject in order to evaluate whether pancreatic enzymes have any benefit on various parameters in chronic pancreatitis, to compare different types of enzyme preparations and to evaluate whether different dosage schedules have any influence on the various outcomes. We included 10 studies in the review. These studies had enrolled small numbers of patients. Though individual studies showed benefit of varying degrees on the parameters mentioned above, we could not pool the results of these studies. With the evidence available so far, no definitive conclusion can be drawn for the benefit of pancreatic enzymes in patients with chronic pancreatitis.

Antioxidants to reduce pain in chronic pancreatitis

Chronic pancreatitis is a persistent inflammation of the pancreas that in the long run can cause irreparable damage. The major causes of chronic pancreatitis are genetics, alcohol toxicity and other conditions that might damage or obstruct the pancreas. This inflammation can cause pain that often is severe and leaves patients socially isolated and unable to perform their jobs. Unfortunately, treatment options are scarce, and often strong morphine‐like pain medications are needed. Patients might benefit from alternative medication without the adverse effects associated with morphine‐like medication. This review summarises the evidence from randomised trials on the effects of antioxidants in chronic pancreatitis. Antioxidants are substances that prevent damage to cells caused by toxic byproducts of oxygen in the body. Levels of these byproducts are increased in chronic pancreatitis. Antioxidants constitute a large group that contains many natural and man‐made products. Examples include vitamin C, vitamin E, flavonoids (present in tea and cocoa) and many specialised medications. We found 12 randomised trials on this topic. The quality of these trials was mixed, and many had small sample sizes and high rates of dropout. Evidence shows that antioxidants may reduce pain in patients with chronic pancreatitis, but the reported reduction in pain was small. Whether this small decrease really had an impact on patients' complaints is not clear. Given the methodological problems of these trials, a strong conclusion could not be drawn. Use of antioxidants resulted in adverse effects in about 16% of study participants. Most adverse effects were mild, such as headache, nausea and constipation. However, participants who developed these adverse effects tended to stop using antioxidant medication. Other outcomes important for decision making such as use of analgesics, rate of exacerbation of pancreatitis and quality of life, were not very well reported. Therefore, we were unable to reach conclusions on these outcomes.

Endoscopy or surgery for patients with chronic pancreatitis and dilated pancreatic duct

Endoscopy and surgery are the treatments of choice in patients with chronic pancreatitis and a dilated pancreatic duct. Pain is the most important symptom in this disease and can be severely debilitating. In addition, chronic pancreatitis can result in malabsorption and/or diabetes due to failure of the gland function of the pancreas.

See all (10)

More about Chronic Pancreatitis

Photo of an adult

Also called: Chronic relapsing pancreatitis, Recurrent pancreatitis, Relapsing pancreatitis, CP

See Also: Acute Pancreatitis

Other terms to know:
Enzymes, Pancreatic Duct

Keep up with systematic reviews on Chronic Pancreatitis:

RSS

PubMed Health Blog...

read all...