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Chronic Pancreatitis: Treatments

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: Treatments

Treatment for chronic pancreatitis may require hospitalization for pain management, IV hydration, and nutritional support. Nasogastric feedings may be necessary for several weeks if the person continues to lose weight.

When a normal diet is resumed, the doctor may prescribe synthetic pancreatic enzymes if the pancreas does not secrete enough of its own. The enzymes should be taken with every meal to help the person digest food and regain some weight. The next step is to plan a nutritious diet that is low in fat and includes small, frequent meals. A dietitian can assist in developing a meal plan. Drinking plenty of fluids and limiting caffeinated beverages is also important.

People with chronic pancreatitis are strongly advised not to smoke or consume alcoholic beverages, even if the pancreatitis is mild or in the early stages.

Complications

People with chronic pancreatitis who continue to consume large amounts of alcohol may develop sudden bouts of severe abdominal pain.

As with acute pancreatitis, ERCP is used to identify and treat complications associated with chronic pancreatitis such as gallstones, pseudocysts, and narrowing or obstruction of the ducts. Chronic pancreatitis also can lead to calcification of the pancreas, which means the pancreatic tissue hardens from deposits of insoluble calcium salts. Surgery may be necessary to remove part of the pancreas.

In cases involving persistent pain, surgery or other procedures are sometimes recommended to block the nerves in the abdominal area that cause pain.

When pancreatic tissue is destroyed in chronic pancreatitis and the insulin-producing cells of the pancreas, called beta cells, have been damaged, diabetes may develop. People with a family history of diabetes are more likely to develop the disease. If diabetes occurs, insulin or other medicines are needed to keep blood glucose at normal levels. A health care provider works with the patient to develop a regimen of medication, diet, and frequent blood glucose monitoring. NIH - National Institute of Diabetes and Digestive and Kidney Diseases

What works? Research summarized

Evidence reviews

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.

Duodenum‐preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis

The pancreas is an organ in the belly (abdomen) that secretes several digestive enzymes into the pancreatic ductal system (tubes that carry the pancreatic juice secreted by the pancreatic cells), which empties into the small bowel. It also comprises the Islets of Langerhans, which secrete several hormones including insulin (helps regulate blood sugar). Chronic pancreatitis is long‐standing and progressive inflammation of the pancreas resulting in destruction and replacement of pancreatic material (tissue) with fibrous tissue. This may lead to digestive enzyme deficiency (shortage) and insulin deficiency leading to diabetes (a lifelong condition that causes a person's blood sugar level to become too high). Alcohol is considered the main cause of acute pancreatitis. Chronic abdominal pain is the major symptom of chronic pancreatitis. The pain is usually in the upper abdomen and is described as deep, penetrating, and radiating to the back. Various theories exist about the reason for pain in chronic pancreatitis. One of the theories is that the disease process obstructs the pancreatic duct. So, surgery to remove the head of the pancreas (the part that is encircled by the duodenum) is recommended for some people with pain uncontrolled with medicines. Major complications of surgery include deaths (mortality) and re‐operations. However, it is unclear whether the duodenum should be excised (surgically removed) along with the head of the pancreas. Thus, we searched for existing studies on the topic. We included all randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) whose results were reported to 22 June 2015.

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.

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Summaries for consumers

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.

Duodenum‐preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis

The pancreas is an organ in the belly (abdomen) that secretes several digestive enzymes into the pancreatic ductal system (tubes that carry the pancreatic juice secreted by the pancreatic cells), which empties into the small bowel. It also comprises the Islets of Langerhans, which secrete several hormones including insulin (helps regulate blood sugar). Chronic pancreatitis is long‐standing and progressive inflammation of the pancreas resulting in destruction and replacement of pancreatic material (tissue) with fibrous tissue. This may lead to digestive enzyme deficiency (shortage) and insulin deficiency leading to diabetes (a lifelong condition that causes a person's blood sugar level to become too high). Alcohol is considered the main cause of acute pancreatitis. Chronic abdominal pain is the major symptom of chronic pancreatitis. The pain is usually in the upper abdomen and is described as deep, penetrating, and radiating to the back. Various theories exist about the reason for pain in chronic pancreatitis. One of the theories is that the disease process obstructs the pancreatic duct. So, surgery to remove the head of the pancreas (the part that is encircled by the duodenum) is recommended for some people with pain uncontrolled with medicines. Major complications of surgery include deaths (mortality) and re‐operations. However, it is unclear whether the duodenum should be excised (surgically removed) along with the head of the pancreas. Thus, we searched for existing studies on the topic. We included all randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) whose results were reported to 22 June 2015.

Treatment methods for people with pancreatic pseudocysts (fluid collections around the pancreas)

The pancreas is an abdominal organ that secretes several digestive enzymes (substances that enable and speed up chemical reactions in the body) into the pancreatic ductal system, which empties into the small bowel. It also contains the Islets of Langerhans, which secrete several hormones, including insulin (that helps to regulate blood sugar). Pancreatic pseudocysts are fluid collections around the pancreas. They arise due to sudden or long‐standing inflammation of the pancreas. While some will disappear when the inflammation of the pancreas settles down, others remain and cause symptoms such as abdominal pain, indigestion, vomiting, and weight loss. Treatments of pancreatic pseudocysts include conservative treatment (watchful monitoring), surgical drainage, which can be performed through a standard cut (open surgical drainage) or by key‐hole surgery (laparoscopic surgical drainage), or endoscopic drainage. In endoscopic drainage, a tube (stent) is inserted with the help of an endoscope (a tube passed through the mouth into the stomach, usually to visualise the abdominal organs from inside the body), that connects the pseudocyst to the stomach or the upper part of the small intestine. The insertion may be further helped by using an endoscopic ultrasound (an ultrasound probe attached to the endoscope; EUS‐guided drainage). Endoscopic ultrasound‐guided drainage may be further assisted by passing a tube through the nose and inserting it into the cyst during EUS‐guided drainage (EUS‐guided drainage with nasocystic drainage). The best way to treat pancreatic pseudocysts is not clear. We sought to resolve this by searching for existing studies on the topic. We included all randomised controlled trials whose results were reported up to 8 September 2015. Apart from using standard Cochrane methods, which allow comparison of only two treatments at a time (direct comparison), we used advanced methods, which allow individual comparison of the different treatments compared in the trials (indirect comparison).

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Terms to know

Enzymes
Protein made by the body that brings about a chemical reaction - for example, the enzymes produced by the gut to aid digestion.
Gallstones
Solid material that forms in the gallbladder or common bile duct. Gallstones are made of cholesterol or other substances found in the gallbladder. They may occur as one large stone or as many small ones, and vary from the size of a golf ball to a grain of sand.
Hydration
The process of combining with water. In medicine, the process of giving fluids needed by the body.
Intravenous (IV)
Into or within a vein. Intravenous usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein. Also called IV.
Nasogastric Tube
A tube that is inserted through the nose, down the throat and esophagus, and into the stomach. It can be used to give drugs, liquids, and liquid food, or used to remove substances from the stomach.

More about Chronic Pancreatitis: Treatments

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See Also: Acute Pancreatitis

Other terms to know: See all 5
Enzymes, Gallstones, Hydration

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