Pancreatitis is inflammation of the pancreas, an organ that sits behind the stomach and is important for digestion. The pancreas produces enzymes that help digest fats, proteins, and carbohydrates, as well as hormones like insulin that regulate blood sugar.
There are two main types of pancreatitis: acute and chronic. Acute pancreatitis comes on suddenly and lasts for a short time, usually a few days. Chronic pancreatitis is inflammation of the pancreas that persists for at least 6 months. So yes, it is certainly possible to have pancreatitis that lasts for months at a time if it is the chronic form.
Some key differences between acute and chronic pancreatitis:
Acute Pancreatitis | Chronic Pancreatitis |
---|---|
Comes on suddenly | Persistent, long-standing inflammation |
Lasts days to weeks | Lasts at least 6 months |
Usually resolves completely with treatment | Can be an ongoing problem |
In this article, we’ll explore the symptoms, causes, diagnosis, and treatment of chronic pancreatitis to better understand how and why it can persist for months at a time.
Symptoms of Chronic Pancreatitis
The most common symptoms of chronic pancreatitis include:
– Severe upper abdominal pain that can radiate to the back. The pain is often recurrent and persists for months.
– Unexplained weight loss and poor appetite. This happens as pancreatic enzymes needed for digestion are lost.
– Oily, foul-smelling stools. Undigested fat appears in the stool.
– Diabetes. Damage to insulin-producing cells in the pancreas causes diabetes in some cases.
– Vitamin deficiencies. Poor absorption of nutrients can lead to deficiencies.
– Jaundice. In advanced disease, bile flow is obstructed leading to yellowed skin.
The pain is often the most prominent and debilitating symptom that persists over time in chronic pancreatitis. Pain can be triggered by eating and relieved by fasting.
Causes and Risk Factors
Common causes and risk factors for developing chronic pancreatitis include:
– Chronic heavy alcohol use. This is the leading cause, accounting for up to 70% of cases.
– Genetic mutations. Mutations in genes like PRSS1, CFTR, and SPINK1 increase risk.
– Autoimmune disease. Primary sclerosing cholangitis and Sjogren’s syndrome are linked.
– High calcium levels. Hypercalcemia can promote pancreas stone formation.
– High triglycerides. Very high blood triglycerides damage the pancreas.
– Smoking. Cigarette smoking significantly increases risk.
– Pancreas surgery. Prior surgery like gallbladder removal may contribute.
– Medications. Some drugs like steroids or azathioprine can cause it.
– Pancreas divisum. An anatomical pancreatic duct variation increases risk.
– Recurrent acute pancreatitis. Repeated bouts of acute pancreatitis can evolve into the chronic form.
– Unknown cause. In about 10-15% of people, no cause is identified (idiopathic).
Typically, more than one factor is at play in causing chronic pancreatitis. The disease develops over time as recurrent injury promotes persistent inflammation and scarring. This is why it can last for months or even years.
Diagnosis
Chronic pancreatitis is often suspected based on symptoms, but various tests help confirm the diagnosis:
– Blood tests check pancreatic enzyme and vitamin levels. Elevated amylase and lipase may indicate pancreatitis.
– Stool tests check for excess fat, which can happen when the pancreas isn’t properly digesting food.
– Imaging tests like CT, MRI, MRCP, or ultrasound allow visualization of the pancreas. They can detect scarring, calcifications, and duct abnormalities consistent with chronic pancreatitis.
– Endoscopic ultrasound uses an endoscope passed through the mouth and stomach to obtain images of the pancreas. It also allows collection of fluid or tissue samples if needed.
– Endoscopic retrograde cholangiopancreatography (ERCP) is another endoscopic procedure that allows imaging of the pancreatic and bile ducts using injection of contrast dye.
– Biopsy of pancreas tissue confirms atrophy and scarring microscopically. A biopsy may be obtained during endoscopic ultrasound.
Since symptoms of chronic pancreatitis are similar to acute pancreatitis or even pancreatic cancer, it is important to undergo appropriate testing to confirm the diagnosis and rule out cancer. Often multiple tests are needed to accurately differentiate between these conditions when pancreatitis persists.
Treatment
Treatment of chronic pancreatitis focuses on relieving symptoms, managing complications, and stopping disease progression through:
– Pain management with medications like NSAIDs, acetaminophen, opioids, or gabapentin
– Low-fat, high-protein diet along with pancreatic enzyme supplements
– Insulin or other medications for diabetes if the pancreas fails to produce insulin
– Vitamin supplements if deficient
– Surgery may be done to relieve severe pain, drain obstructions, or remove affected parts of the pancreas
– Treatment of contributing factors – stopping alcohol use, modifying hypertriglyceridemia diet, or prescribing corticosteroids for autoimmune pancreatitis
– Alternative therapies like antioxidants or probiotics are sometimes used but benefits are uncertain
– Follow up testing to monitor condition
Treatment is tailored to the individual based on symptoms present and root cause of the chronic pancreatitis when known. Pain management and diet changes are almost always part of the treatment plan.
Prognosis and Outcomes
With treatment, many people with chronic pancreatitis can manage their condition and have good quality of life. However, severe cases can lead to serious complications:
– Worsening diabetes is common, eventually requiring insulin.
– Malnutrition and vitamin deficiencies.
– Bile duct or intestinal obstruction may require ERCP or surgery.
– Pseudocysts can develop in the pancreas and sometimes get infected.
– Increased risk of pancreatic cancer – chronic pancreatitis patients should be screened.
– Osteoporosis, kidney failure, severe pain, and digestive issues that impair quality of life.
For mild or moderate chronic pancreatitis, proper treatment can control symptoms and complications. But severe chronic pancreatitis can be very difficult to manage and outcomes are poorer.
The prognosis depends on the underlying cause – for example, autoimmune pancreatitis has better outcomes than that caused by chronic alcohol use. Early diagnosis combined with abstinence from alcohol and smoking can improve prognosis.
Conclusion
In summary, chronic pancreatitis is persistent inflammation of the pancreas that lasts at least 6 months. The hallmark symptom is recurrent abdominal pain, along with weight loss and greasy stools. It is most often caused by heavy alcohol use or genetic factors. Through imaging tests, lab tests, and sometimes biopsy, doctors can confirm the diagnosis when pancreatitis lasts more than a few weeks. Treatment focuses on pain relief, diet changes, stopping the underlying cause, and preventing complications like diabetes and vitamin deficiencies. While mild cases can be managed well, severe chronic pancreatitis can lead to serious outcomes like pancreatic cancer, kidney failure, and severe disability. With early treatment and abstinence from contributing factors like alcohol, the prognosis can be good. But chronic pancreatitis is a challenging progressive disease that often impacts patients for months to years once it develops.