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Introduction 

Chronic pancreatitis is a condition where the pancreas (a small organ located behind the stomach and below the ribcage) becomes permanently damaged from inflammation.

It's different to acute pancreatitis, where the inflammation is only short-term.

The most common symptom of chronic pancreatitis is repeated episodes of abdominal (tummy) pain, which can be severe.

Other symptoms tend to develop as the damage to the pancreas progresses, such as producing greasy, foul-smelling stools

When to seek medical advice

Always visit your GP if you're experiencing severe pain – it's a warning sign that something is wrong.

Why it happens

Long-term alcohol misuse is responsible for around 7 out of every 10 cases of chronic pancreatitis. This is because heavy drinking over a number of years can repeatedly damage the pancreas.

Less common causes include:

  • smoking
  • a problem with the immune system, causing it to attack the pancreas
  • an inherited genetic mutation disrupting the functions of the pancreas

In as many as 3 out of 10 people with the condition, the cause cannot be identified – this is known as "idiopathic" chronic pancreatitis.

Who's affected

Chronic pancreatitis can affect people of any age, but is most common in middle-aged men aged between 45 and 54.

Between 2012 and 2013, over 35,000 people visited hospitals in England with the condition.

How it's treated

In most cases of chronic pancreatitis, there's no specific treatment to reduce the inflammation and repair the damage to the pancreas.

Treatment mainly focuses on lifestyle changes (see below) and medication to relieve the pain. Surgery is sometimes needed to treat severe chronic pain that doesn't respond to painkillers.

However, the pain can be difficult to treat and can seriously affect your quality of life.

People who don't smoke cigarettes and avoid drinking alcohol tend to experience less pain and live longer than those who continue to drink and smoke after receiving a diagnosis.

Complications

Living with chronic pain can cause mental as well as physical strain. It's important to speak to your GP if you're experiencing stress, anxiety ordepression caused by chronic pancreatitis.

Diabetes is a common complication of chronic pancreatitis and affects about a third of people with the condition. It occurs when the pancreas is damaged and unable to produce insulin.

People with chronic pancreatitis also have an increased risk of developing pancreatic cancer.

The most common symptom of chronic pancreatitis is repeated episodes of abdominal (tummy) pain. Eventually, there may also be digestion problems.

The pain usually develops in the middle or left side of the abdomen and can sometimes travel along your back. It's been described as a burning or shooting pain which comes and goes, but can last for several hours or days, in some cases.

Some people also experience symptoms of nausea and vomitingduring the pain. As chronic pancreatitis progresses, the painful episodes may become more frequent and severe.

Although the pain sometimes occurs after eating a meal, there's often no trigger.

Eventually, a constant mild to moderate pain can develop in the abdomen in between episodes of severe pain. This is most common in people who continue to drink alcohol after being diagnosed with chronic pancreatitis.

Advanced chronic pancreatitis

Additional symptoms can occur when the pancreas loses its ability to produce digestive juices, which help to break down food in the digestive system. The pancreas usually only loses these functions many years after the original symptoms started.

The absence of digestive juices makes it difficult for your digestive system to break down fats and certain proteins. This can cause your stools to become particularly smelly and greasy, and make them difficult to flush down the toilet.

You may also experience:

  • weight loss
  • loss of appetite
  • jaundice (yellowing of the skin and eyes)
  • symptoms of diabetes – such as feeling very thirsty, urinating frequently and feeling very tired
  • ongoing nausea and vomiting

When to seek medical advice

Always visit your GP if you're experiencing severe pain, as this is a warning sign that something is wrong.

You should also visit your GP if you develop symptoms of jaundice. Jaundice can have a range of causes other than pancreatitis, but it's usually a sign that there's something wrong with your digestive system.

You should also visit your GP if you develop persistent vomiting.

Causes of chronic pancreatitis 

Most cases of chronic pancreatitis are associated with drinking excessive amounts of alcohol over a long period of time.

However, in up to 3 out of 10 people with the condition, the cause can't be identified  known as "idiopathic" chronic pancreatitis.

Some of the known causes of chronic pancreatitis are outlined below.

Alcohol consumption

Heavy drinking over many years can cause repeated episodes of acute pancreatitis. Acute pancreatitis is usually a short-term condition, but it can recur if you continue to drink alcohol.

Over time, repeated inflammation causes permanent damage to the pancreas, resulting in chronic pancreatitis.

Anyone who regularly consumes alcohol has an increased risk of chronic pancreatitis, although only a minority develop the condition.

Problems with the immune system

Rare cases of chronic pancreatitis are the result of a problem with the immune system, which causes it to attack the pancreas. This is known as "autoimmune pancreatitis" and it's not clear exactly why it happens.

Many people with autoimmune pancreatitis also have other conditions caused by the immune system attacking healthy tissue. These includeulcerative colitis or Crohn’s disease, both of which cause inflammation inside the digestive system.

Genetics

Some cases of chronic pancreatitis are inherited. This is thought to be caused by mutations (alterations) in a number of genes, including genes called PRSS1 and SPINK-1. These mutations disrupt the normal working of the pancreas.

Genetic mutations may also have a role in the effect of alcohol on your pancreas. Evidence suggests that certain genetic mutations make the pancreas more vulnerable to the harmful effects of alcohol.

Certain mutations of the CFTR gene, responsible for cystic fibrosis, are also thought to cause chronic pancreatitis in a small amount of cases.

Other causes

Several other rare causes of chronic pancreatitis have also been identified, including:

  • injury to the pancreas
  • blocked or narrowed openings (ducts) of the pancreas
  • smoking
  • radiotherapy to the abdomen (tummy)
  • Causes of chronic pancreatitis 

    Most cases of chronic pancreatitis are associated with drinking excessive amounts of alcohol over a long period of time.

    However, in up to 3 out of 10 people with the condition, the cause can't be identified  known as "idiopathic" chronic pancreatitis.

    Some of the known causes of chronic pancreatitis are outlined below

  • Alcohol consumption

  • Heavy drinking over many years can cause repeated episodes of acute pancreatitis. Acute pancreatitis is usually a short-term condition, but it can recur if you continue to drink alcohol.

    Over time, repeated inflammation causes permanent damage to the pancreas, resulting in chronic pancreatitis.

    Anyone who regularly consumes alcohol has an increased risk of chronic pancreatitis, although only a minority develop the

    Problems with the immune system

    Rare cases of chronic pancreatitis are the result of a problem with the immune system, which causes it to attack the pancreas. This is known as "autoimmune pancreatitis" and it's not clear exactly why it happens.

    Many people with autoimmune pancreatitis also have other conditions caused by the immune system attacking healthy tissue. These includeulcerative colitis or Crohn’s disease, both of which cause inflammation inside the digestive system.

    Genetics

    Some cases of chronic pancreatitis are inherited. This is thought to be caused by mutations (alterations) in a number of genes, including genes called PRSS1 and SPINK-1. These mutations disrupt the normal working of the pancreas.

    Genetic mutations may also have a role in the effect of alcohol on your pancreas. Evidence suggests that certain genetic mutations make the pancreas more vulnerable to the harmful effects of alcohol.

    Certain mutations of the CFTR gene, responsible for cystic fibrosis, are also thought to cause chronic pancreatitis in a small amount of cases.

    Other causes

    Several other rare causes of chronic pancreatitis have also been identified, including:

    • injury to the pancreas
    • blocked or narrowed openings (ducts) of the pancreas
    • smoking
    • radiotherapy to the abdomen (tummy)

Treating chronic pancreatitis 

Treatment for chronic pancreatitis aims to help control the condition and reduce any symptoms.

Lifestyle changes

If you're diagnosed with chronic pancreatitis, some lifestyle changes will be recommended. These are described below.

Avoiding alcohol

The most important thing you can do is to stop drinking alcohol, even if it isn't the cause of your condition. This helps to prevent further damage to your pancreas and may help to reduce the pain.

If you continue to drink alcohol, it's likely that you'll experience debilitating pain and you'll be more likely to die from a complication of chronic pancreatitis.

Some people with chronic pancreatitis caused by alcohol consumption have a dependency on alcohol and require additional help and support to stop drinking. If this applies to you, talk to your GP about getting help to stop drinking.

Treatment options for alcohol dependence include:

Stopping smoking

If you smoke, you should stop. Smoking can speed up the progress of chronic pancreatitis, making it more likely that your pancreas will lose its function.

It's recommended that you use an anti-smoking treatment, such as nicotine replacement therapy (NRT) or bupropion (a medication used to reduce cravings for cigarettes). People who use these types of treatments have a much greater success rate in permanently stopping smoking than those who try to quit using willpower alone.

If you want to give up smoking, it's a good idea to start by visiting your GP. They'll be able to give you help and advice about quitting and can refer you to an  Stop Smoking support service.

These services offer the best support for people who want to give up smoking. Studies show you are four times more likely to give up smoking if you do it through the . 

Dietary changes

As chronic pancreatitis can affect your ability to digest certain foods, you may need to change your diet. In particular, a low-fat diet is recommended.

Your GP may be able to provide you with appropriate dietary advice, or may refer you to a dietitian, who will draw up a suitable dietary plan.

Enzyme supplements

You may be given pancreatic enzyme supplements, which is medication containing an artificial version of the enzymes produced by your pancreas. These supplements may help to improve the effectiveness of your digestive system.

Side effects of pancreatic enzyme supplements can include diarrhoea,constipation, nausea, vomiting and stomach pains.

Talk to your GP if you're experiencing troublesome side effects, as your dosage may need to be adjusted.

Steroid medication

If you have chronic pancreatitis caused by problems with your immune system, treatment is relatively straightforward. The inflammation affecting the pancreas can usually be relieved using steroid medication (corticosteroids).

However, taking corticosteroids for a long time can cause side effects, such as osteoporosis and weight gain.

Pain relief

Pain relief is an important part of the treatment of chronic pancreatitis. At first, mild painkillers will be used, but more powerful ones will be needed if these don't work.

Mild painkillers

In most cases, the first painkiller used is paracetamol or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen.

Taking NSAIDs on a long-term basis can increase your risk of developing stomach ulcers, so you may be prescribed an additional medication called a proton pump inhibitor (PPI) to protect against this.

Stronger painkillers

If NSAIDs or paracetamol prove to be ineffective in controlling your pain, it's likely that you'll need an opiate-based painkiller, such as codeine or tramadol. Side effects of these types of medication can include constipation, nausea, vomiting and drowsiness.

The side effect of constipation can be particularly troublesome if you need to take an opiate-based painkiller on a long-term basis. You may be prescribed a laxative to help relieve your constipation.

If you feel drowsy after taking an opiate-based painkiller, avoid driving and using heavy tools or machines.

Severe pain

If you experience an attack of very severe pain, you may need a stronger opiate-based painkiller, such as morphine or pethidine. These have similar side effects to the opiate-based painkillers mentioned above.

Long-term use of these stronger opiate-based painkillers isn't usually recommended, because there's a high risk of addiction. Therefore, if you have persistent severe pain, surgery is usually recommended.

In some cases, an additional medication called amitriptyline may be recommended. Amitriptyline was originally designed to treat depression, but it can help to relieve pain in some people.

If medication isn't effective, severe pain can sometimes be temporarily relieved for a few weeks or months using a procedure called a nerve block. This is an injection that blocks the pain signals from the pancreas.

Severe episodes

If the inflammation of your pancreas suddenly gets worse, you may need a short stay in hospital for treatment.

This may involve having fluids delivered directly into a vein, and oxygen supplied through tubes into your nose.

Surgery

Surgery can be used to treat severe pain in people with chronic pancreatitis. Depending on the exact cause of your pain, there are a variety of surgical techniques that may be used. Some of these are outlined below.

Endoscopic surgery

Patients with stones in the opening of their pancreas (the pancreatic duct) may benefit from endoscopic surgery and a treatment called lithotripsy.

Lithotripsy involves using shock waves to break the stone into smaller pieces. An endoscope (a long, thin flexible tube with a light source and a video camera at one end) is then used to pass surgical instruments into the pancreatic duct so the pieces can be removed.

This treatment may improve pain to some extent, but the benefit may not be permanent.

Pancreas resection

In cases where specific parts of the pancreas are inflamed and causing severe pain, these parts can be surgically removed. This type of surgery is called a pancreas resection.

Pancreas resection can also be used if endoscopic treatment is ineffective.

The technique used for pancreas resection depends on exactly which parts need to be removed. For example, some techniques involve removing the gallbladder, along with parts of the pancreas.

The different surgical techniques tend to have the same levels of effectiveness in terms of reducing pain and preserving the function of the pancreas, although some of the more complex techniques have an increased risk of complications, such as infection and internal bleeding. Simpler procedures have a lower risk of complications and usually have faster recovery times.

Discuss the pros and cons of the appropriate pancreas resection techniques with your surgical team before making a decision.

Total pancreatectomy

In the most serious cases of chronic pancreatitis, where the pancreas has been extensively damaged, it may be necessary to remove the entire pancreas. This is known as a total pancreatectomy.

A total pancreatectomy can be very effective in treating pain. However, you'll no longer be able to produce the insulin that's needed by your body. To overcome this problem, a relatively new technique called autologous pancreatic islet cell transplantation (APICT) is sometimes used.

During APICT, the islet cells responsible for producing insulin are removed from your pancreas, before your pancreas is surgically removed.

The islet cells are mixed with a special solution, which is injected into your liver. If the APICT procedure is successful, the islet cells remain in your liver and begin to produce insulin.

  • one-to-one counselling
  • self-help groups – such as Alcoholics Anonymous
  • a medication called acamprosate that can help to reduce cravings for alcohol

    Pancreatitis chronic
    Pancreatitis chronic