Overview

Chronic pancreatitis is a condition where the pancreas has become permanently damaged from inflammation and stops working properly.

The pancreas is a small organ, located behind the stomach, that helps with digestion.

Chronic pancreatitis can affect people of any age, but it usually develops between the ages of 30 and 40 as a result of heavy drinking over many years. It's more common in men.

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

Most people with chronic pancreatitis have had 1 or more attacks of acute pancreatitis.

Symptoms of chronic pancreatitis

The most common symptom of chronic pancreatitis is repeated episodes of severe pain in your tummy (abdomen).

The pain usually develops in the middle or left side of your tummy and can move along your back.

It's been described as a burning or shooting pain that comes and goes, but may last for several hours or days.

Although the pain sometimes comes on after eating a meal, there's often no trigger. Some people might feel sick and vomit.

As the condition progresses, the painful episodes may become more frequent and severe.

Eventually, a constant dull pain can develop in your tummy, between episodes of severe pain.

This is most common in people who continue to drink alcohol after being diagnosed with chronic pancreatitis.

Some people who stop drinking alcohol and stop smoking may find the pain is less severe.

Advanced chronic pancreatitis

Other symptoms develop as the damage to the pancreas progresses and it becomes unable to produce digestive juices, which help to break down food.

The absence of digestive juices means it's harder to break down fats and some proteins. This can cause your poo to become very smelly and greasy, and make it difficult to flush down the toilet.

The pancreas usually only loses these functions many years after the first symptoms started.

You may also experience:

• weight loss
• loss of appetite
• yellowing of the skin and eyes (jaundice)
• symptoms of diabetes – such as feeling very thirsty, needing to pee more often than usual and feeling very tired
• ongoing nausea and sickness (vomiting)

When to get medical advice

See a GP immediately if you're experiencing severe pain, as this is a warning sign that something is wrong.

If this isn't possible, call 111, NHS 111 Wales .

You should also see a GP as soon as you can if you:

• develop symptoms of jaundice
• keep being sick

Jaundice can have a range of causes other than pancreatitis, but it's usually a sign there's something wrong with your digestive system.

Diagnosing chronic pancreatitis

A GP will ask about your symptoms and may examine you.

They'll refer you to a specialist for further tests if they think you have chronic pancreatitis.

The specialist will be able to confirm whether you have the condition.

Tests

Tests and scans are usually carried out in your local hospital.

They may include:

• an ultrasound scan – where sound waves are used to create a picture of your pancreas
• a CT scan – where a series of X-rays are taken to build up a more detailed 3D image of your pancreas
• an endoscopic ultrasound scan – where a long, thin tube containing a camera is passed through your mouth and down into your stomach to take pictures of your pancreas
• magnetic resonance cholangiopancreatography (MRCP) – a type of MRI scan that takes a detailed image of your pancreas and the organs around it

Biopsy

Sometimes the symptoms of chronic pancreatitis can be very similar to pancreatic cancer.

You may need a biopsy, where a small sample of cells is taken from the pancreas and sent to a laboratory to be checked, to rule this out.

Causes of chronic pancreatitis

The most common cause of chronic pancreatitis is drinking excessive amounts of alcohol over many years.

This can cause repeated episodes of acute pancreatitis, which results in increasing damage to the organ.

In children the most common cause is cystic fibrosis.

Less common causes include:

• smoking
• the immune system attacking the pancreas (autoimmune chronic pancreatitis)
• inheriting a faulty gene that stops the pancreas from working properly
• injury to the pancreas
• gallstones blocking the openings (ducts) of the pancreas
• radiotherapy to the tummy

In some cases, no cause can be identified. This is called idiopathic chronic pancreatitis.

Treatment for chronic pancreatitis

The damage to the pancreas is permanent, but treatment can help control the condition and manage any symptoms.

People with chronic pancreatitis are usually advised to make lifestyle changes, such as stopping drinking alcohol and stopping smoking. They're also given medicine to relieve pain.

Surgery may also be an option for those experiencing severe pain.

Complications

Living with chronic pain can cause mental as well as physical strain.

See a GP if you're experiencing stress, anxiety or depression caused by chronic pancreatitis.

About 1 in 3 people with chronic pancreatitis will eventually develop a type of diabetes known as type 3c diabetes.

This occurs when the pancreas can no longer produce insulin because it's become so damaged.

People with chronic pancreatitis can sometimes develop sacs of fluid on the surface of their pancreas (pseudocysts). These can cause bloating, indigestion and dull tummy pain.

These cysts often disappear on their own. But sometimes they need to be drained using a technique called endoscopic ultrasound drainage, or endoscopic transpapillary drainage.

Chronic pancreatitis increases your risk of pancreatic cancer, although the chance is still small.

Support for people living with chronic pancreatitis

Any long-term health condition, particularly one that causes recurring episodes of pain or constant pain, can affect your emotional and psychological health.

See a GP if you're experiencing psychological and emotional difficulties. There are medicines available that can help with stress, anxiety and depression.

Talking to other people with the same condition can often reduce feelings of isolation and stress.

The charity Guts UK, may be able to put you in touch with a local support group.

Treatment

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

Lifestyle changes

Avoiding alcohol

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

If you continue to drink alcohol, it's likely you'll experience pain that stops you carrying out your day-to-day activities and also be more likely to develop complications.

Some people with chronic pancreatitis have a dependency on alcohol and need help and support to stop drinking. See your GP if this applies to you.

Treatment for alcohol dependence includes:

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

Stopping smoking

If you smoke, you should stop. Smoking can speed up the damage caused by chronic pancreatitis, making it more likely your pancreas will stop working sooner.

You can use an anti-smoking treatment such as nicotine replacement therapy (NRT) or bupropion – a medicine used to reduce cravings for cigarettes.

See a GP for help and advice about quitting or you can call Help Me Quit on 0808 250 4024 (Wales only) for more advice.

Dietary changes

Because chronic pancreatitis can affect your ability to digest certain foods, you may need to change your diet.

A GP may be able to provide you with dietary advice, or you can ask them or your hospital doctor to refer you to a dietitian who will draw up a suitable dietary plan.

A low-fat, high-protein, high-calorie diet with fat-soluble vitamin supplements is usually recommended. But do not make changes to your diet without consulting a health professional.

Enzyme supplements

You may be given pancreatic enzyme supplements to help your digestive system work more effectively.

Side effects of these supplements include diarrhoea, constipation, feeling sick, vomiting and tummy pains. See a GP if you experience side effects, as your dosage may need to be adjusted.

Steroid medicine

Steroid medicine is recommended for people with chronic pancreatitis caused by problems with the immune system because it helps to relieve the inflammation of the pancreas.

However, taking steroid medication 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.

Mild painkillers

In most cases, the first painkillers used are paracetamol, or anti-inflammatories such as ibuprofen.

But taking anti-inflammatory painkillers on a long-term basis can increase your risk of developing stomach ulcers, so you may be prescribed a proton pump inhibitor (PPI) to protect against this.

Stronger painkillers

If paracetamol or anti-inflammatories don't control the pain, you may need an opiate-based painkiller, such as codeine or tramadol. Side effects include constipation, nausea, vomiting and drowsiness.

Constipation can be particularly difficult to manage, so you may be prescribed a laxative to help relieve this.

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

Severe pain

If your pain is severe, you may be referred to a specialist (a gastroenterologist or pancreatico-biliary surgeon) or pain centre for further assessment.

You may be offered surgery to help relieve the pain or treat any complications.

In some cases, additional medicine – called amitriptyline, gabapentin or pregabalin – may be recommended to help relieve the pain.

If this isn't effective, severe pain can sometimes be relieved for a few weeks or months using an injection called a nerve block. This 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 might involve having fluids delivered directly into a vein and oxygen through tubes into your nose.

Surgery

Surgery can be used to treat severe pain in people with chronic pancreatitis.

Endoscopic surgery

Patients with gallstones 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 stones into smaller pieces. An endoscope is then used to access 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, they can be surgically removed. This is called a pancreas resection and may also be offered if endoscopic treatment doesn't work.

The exact technique used for pancreas resection depends on which parts need to be removed.

Speak with your surgical team about the benefits and risks of the procedure before deciding to go ahead with it.

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 (total pancreatectomy).

This can be very effective in treating pain, but you wont be able to produce the insulin that's needed by your body any more. To overcome this problem, a 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 then mixed with a special solution and injected into your liver.

If APICT is successful, the islet cells remain in your liver and begin to produce insulin.

In the short term, APICT appears to be effective, but you may need additional insulin treatment in the long term.

Other tests and checks

If you've been diagnosed with chronic pancreatitis, you should be offered:

• annual checks (every 6 months in under-16s) to make sure your diet is giving you the nutrients you need
• a bone density assessment every 2 years – problems with digesting foods may affect your bone health
• a blood test for diabetes every 6 months
• an annual check for pancreatic cancer if the cause of chronic pancreatitis is hereditary