Brief Overview: Chronic pancreatitis is a condition that involves damage to the pancreas from long term inflammation and impairs the pancreas’s ability to function properly. There are many causes of chronic pancreatitis.
Prevalence: According to UpToDate, “limited evidence suggests that the incidence and prevalence of chronic pancreatitis is approximately 25/100,000 and 92/100,000 persons, respectively.”
Etiology: According to UpToDate, the TIGAR-O classification system categorizes causes of chronic pancreatitis as toxic-metabolic (alcohol, smoking, hypertriglyceridemia, diabetes, etc.), idiopathic (no known cause), genetic, autoimmune, recurrent and severe acute pancreatitis, and obstructive.
Risk Factors:
- Chronic alcohol abuse
- Smoking
- History of recurrent acute pancreatitis
- Elevated triglycerides
- Family history/genetics
- Autoimmune conditions
- Cystic Fibrosis
Commonly Associated Conditions:
- Cystic Fibrosis
- Diabetes
- IBD
- Exocrine and endocrine pancreatic insufficiency
Common Medications:
- Pain management:
- Tylenol, NSAIDs
- Opioids if non-narcotics are unsuccessful
- If opioids are required, SSRIs, tricyclic antidepressants, duloxetine, gabapentin, etc. will likely be prescribed as well
- Antioxidant supplementation – Vitamin E, Vitamin C, beta-carotene, selenium, and methionine
- Pancreatic enzyme supplementation
Common Labs, Imaging, and Tests:
- Abdominal imaging – CT, MRI, ultrasound, x-ray
- Endoscopic Ultrasound
- Upper Endoscopy
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Direct pancreatic function testing
- Labs may include: fasting serum triglycerides, IgG4, genetic testing in select patients, vitamin D, CMP, amylase, lipase, RF, ANA,
- Stool tests
Common Symptoms:
- Abdominal pain
- Nausea, vomiting
- Diarrhea/loose stools
- Weight loss
- Oily or floating stools
Common Treatments:
- Medications (see above)
- Alcohol and tobacco cessation
- Dietary modifications
- Vitamin and nutritional supplementation as needed
Physical Findings:
- Abdominal tenderness
- Weight loss
Potential Complications and Contraindications:
- Increased risk of pancreatic cancer
- Blockage of the bile duct
- Osteoporosis or osteopenia
- Increased risk of bone fracture
- Opioid dependency if treated with opioids to manage pain
- Diabetes (type 3c)
General Health and Lifestyle Guidance:
- Avoid alcohol
- Smoking cessation
- Adequate hydration – discuss hydration needs with your healthcare provider
- Discuss any recommended dietary modifications with your healthcare provider
Suggested Questions to Ask Patients:
- Have you had episodes of severe abdominal pain in the past?
- Do you have greasy or floating stools?
- Have you lost weight unintentionally?
- Do you consume alcohol or use tobacco?
- Have you been tested for diabetes or vitamin deficiencies?
Suggested Talking Points:
- Make sure to follow your treatment plan as directed by your healthcare provider. Report any challenges with following your treatment plan, including any side effects or new symptoms
- Report any new or worsening symptoms to your healthcare provider
- The goal of treatment is to reduce your symptoms and make your condition more manageable
Sources:
- UpToDate
- Johns Hopkins Medicine
- Cedars Sinai
- The National Pancreas Foundation
- National Library of Medicine National Center for Biotechnology Information