What is chronic pancreatitis?

Chronic pancreatitis may happen after one or more episodes of acute pancreatitis. The most common cause is long-term alcohol use.

What happens when you have chronic pancreatitis varies. Pain that continues (persistent) or comes back (recurrent) and other problems often occur. Problems may include flare-ups of symptoms, fluid buildup, and blockage of a blood vessel, the bile duct, or the small intestine.

If much of the tissue in the pancreas has died, you may not get enough nutrients. So you may become malnourished. This happens because the pancreas no longer makes the enzymes needed to digest fat and protein. So fat is released into your stool. This condition, called steatorrhea, causes loose, pale, very foul-smelling stools. The stools may float in the toilet bowl.

If the damaged pancreas stops making enough insulin, you also may get diabetes.

Chronic pancreatitis raises your risk for pancreatic cancer. About 4 out of 100 people with chronic pancreatitis get this cancer.

The main symptom is pain in the upper part of the belly. The pain may be mild, and it may feel like it goes through the belly to the back. Sitting up or leaning forward sometimes eases the pain. Pain may be constant or it may come and go.

For chronic pancreatitis, you should not drink alcohol. You may need pain medicine, insulin, and enzyme pills. If you have gallstones or there is severe damage to the pancreas, you may need a procedure or surgery.

Pain is a frustrating, sometimes debilitating aspect of ongoing (chronic) pancreatitis. Many people have pain for many years.

Pain may decrease as the damaged pancreas loses its ability to produce enzymes. But it may take years for the pancreas to stop producing enzymes. In many people, this process never occurs.

If you are having debilitating pain from chronic pancreatitis, you may be referred to a pain clinic.

Treatment for pain includes avoiding alcohol, eating a low-fat diet, using pain medicine, and in some cases taking enzyme pills to help rest your pancreas.

Analgesics.

You may be able to help your pain with over-the-counter pain medicines like acetaminophen, aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Be safe with medicines. Read and follow all instructions on the label. If over-the-counter pain medicines don't control your pain, your doctor may prescribe another type of pain medicine.

Tricyclic antidepressants.

These medicines (such as amitriptyline or imipramine) may help people sleep and cope with pain and depression.

Pancreatic enzyme supplements.

People can take oral enzyme supplements, which may reduce pain in some people, particularly those who have mild or moderate disease.

Stents.

A procedure called endoscopic retrograde cholangiopancreatography (ERCP) can be used to place small supports (stents) in a narrow pancreatic duct.

Celiac plexus nerve block.

An injection of alcohol or corticosteroids into this bundle of abdominal nerves may provide temporary relief.

Surgery.

Pain may be reduced by removing stones from the pancreas and draining pancreatic ducts. For some cases of chronic pain, total pancreatectomy (removal of the pancreas) may be considered.

You may need medicines to treat chronic pancreatitis. They may include:

Pain medicine.

Over-the-counter medicines like acetaminophen or ibuprofen may be tried first. If these don't work to help your pain, your doctor may prescribe other pain medicines.

Pancreatic enzyme supplements.

In advanced chronic pancreatitis, the pancreas may stop making the enzymes needed to digest fats, proteins, and carbohydrates. Enzyme supplements that you can take with meals can help the body digest fats. This helps you keep the nutrients from your food and gain weight.

People who are allergic to pork or who don't eat pork for other reasons should not take these enzymes. They are made from pork protein.

Insulin.

Advanced chronic pancreatitis can lead to diabetes if the part of the pancreas that makes insulin becomes damaged.

Be safe with medicines. Read and follow all instructions on the label.

If you have chronic pancreatitis caused by alcohol use, you'll need to quit drinking to reduce severe pain and other problems that can happen (complications). If you drink large amounts of alcohol when you have chronic pancreatitis, it can shorten your life.

It's not clear how your diet might affect pancreatitis. But doctors recommend that you eat low-fat foods and stay at a healthy weight.

Chronic pancreatitis is long-term inflammation of the pancreas that leads to scarring and permanent damage. It can cause pain and problems digesting food. It can also cause diabetes.

Long-term alcohol use is the most common cause of chronic pancreatitis. Other causes include cystic fibrosis and a recurrent blockage of the ducts that drain the pancreas. Chronic pancreatitis may run in families. And smoking cigarettes also seems to raise the risk for it.

• Do not drink alcohol. It may make your pain worse and cause other problems. Tell your doctor if you need help to quit. Counseling, support groups, and sometimes medicines can help you stay sober.
• Ask your doctor if you need to take pancreatic enzyme pills to help your body digest fat and protein.
• Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.

Eat a low-fat diet

• Eat many small meals and snacks each day instead of three large meals.
• Choose lean meats.
  • Eat no more than 5 to 6½ ounces of meat a day.
  • Cut off all fat you can see.
  • Eat chicken and turkey without the skin.
  • Many types of fish, such as salmon, lake trout, tuna, and herring, provide healthy omega-3 fat. But avoid fish canned in oil, such as sardines in olive oil.
  • Bake, broil, or grill meats, poultry, or fish instead of frying them in butter or fat.
• Drink or eat nonfat or low-fat milk, yogurt, cheese, or other milk products each day.
  • Read the labels on cheeses, and choose those with less than 5 grams of fat an ounce.
  • Try fat-free sour cream, cream cheese, or yogurt.
  • Avoid cream soups and cream sauces on pasta.
  • Eat low-fat ice cream, frozen yogurt, or sorbet. Avoid regular ice cream.
• Eat whole-grain cereals, breads, crackers, rice, or pasta. Avoid high-fat foods such as croissants, scones, biscuits, waffles, doughnuts, muffins, granola, and high-fat breads.
• Flavor your foods with herbs and spices (such as basil, tarragon, or mint), fat-free sauces, or lemon juice instead of butter. You can also use butter substitutes, fat-free mayonnaise, or fat-free dressing.
• Try applesauce, prune puree, or mashed bananas to replace some or all of the fat when you bake.
• Limit fats and oils, such as butter, margarine, mayonnaise, and salad dressing, to no more than 1 tablespoon a meal.
• Avoid high-fat foods, such as:
  • Chocolate, whole milk, ice cream, processed cheese, and egg yolks.
  • Fried or buttered foods.
  • Sausage, salami, and bacon.
  • Cinnamon rolls, cakes, pies, cookies, and other pastries.
  • Prepared snack foods, such as potato chips, nut and granola bars, and mixed nuts.
  • Coconut and avocado.
• Learn how to read food labels for serving sizes and ingredients. Fast-food and convenience-food meals often have lots of fat.