24th July 2023

Chronic pancreatitis

Chronic pancreatitis refers to irreversible inflammation and/or fibrosis of the pancreas, which generally occurs as a consequence of recurrent acute pancreatitis. Repeated inflammation leads to fibrosis and calcification of the gland.

Clinically, it presents as episodic severe abdominal pain, associated with nausea and vomiting, such as in acute pancreatitis. An affected patient will have a background of previous pancreatitis. The causes are therefore the same as for acute pancreatitis; although most commonly it is patients with a history of alcohol excess who are most at risk of chronic pancreatitis, and it is generally associated with a failure to reduce alcohol intake.

Assessment and diagnosis are similar to acute pancreatitis – and it should be suspected in any patient with a background of the former. CT and MRI can be used to demonstrate the extent of fibrosis and any calcification.

Complications include pancreatitis endocrine insufficiency, and exocrine sufficiency due to the direct damage to islets of Langerhans and acinar cells, respectively. This can therefore lead to diabetes mellitus and malabsorption. Patients with chronic pancreatitis, therefore, may be malnourished.

Management is supportive, including analgesia for episodic flare ups, nutritional support, management of complications, and screening for the aforementioned complications. Patients are also at an increased risk of pancreatic cancer. Simple analgesia should be first started, i.e. paracetamol and NSAIDs, and then escalated to weak and strong opioids, as appropriate.

Crucial is risk reduction, such as alcohol and smoking cessation, and medical management of hypercalcaemia and hypertriglyceridemia.