Chronic pancreatitis

The pancreas: What is it? The pancreas is a gland located behind the stomach that performs two essential functions: digesting nutrients through the secretion of digestive enzymes, and regulating blood sugar levels through the secretion of insulin. 

Chronic pancreatitis is prolonged inflammation of the pancreas. Over time, the pancreas changes and may develop stones or narrowing of its main duct (strictures). These changes cause pain, difficulty digesting food and disturbances in blood sugar regulation. Excessive alcohol consumption is the most common cause of chronic pancreatitis. Sometimes, there are genetic alterations that explain chronic pancreatitis. However, in some cases, no cause can be identified: this is referred to as idiopathic chronic pancreatitis. Sometimes, the disease is of autoimmune origin—that is, it is caused by an abnormal reaction of the immune system against the pancreas—with or without specific antibodies in the blood: in this case, it is referred to as autoimmune pancreatitis.

• Abdominal pain, either in the form of acute episodes (attacks of acute pancreatitis) or continuously.
• Greasy stools (steatorrhoea), caused by poor digestion of fats.
• Weight loss and malnutrition, due to insufficient absorption of nutrients.
• Biological abnormalities: deficiencies in certain minerals (sodium, potassium), vitamins and trace elements.
• Diabetes, caused by damage to the insulin-producing cells.

You will first meet a pancreas specialist (gastroenterologist), who will review your symptoms and medical and surgical history. Further examinations will then be carried out:

• A complete blood test to assess your general condition, kidney function, blood sugar level, vitamin and mineral levels, and the condition of your liver
• Blood antibody testing if an autoimmune origin is suspected
• A genetic analysis, depending on your situation
• A stool examination, if necessary
• A CT scan and magnetic resonance imaging to assess your pancreas
• A bone densitometry scan (to check the strength of your bones)

Management involves several specialists working together under the coordination of your gastroenterologist:

• A dietitian will help you adapt your diet
• Medicines and vitamin supplements will be prescribed to control pain and correct deficiencies
• Pancreatic enzyme replacement therapy if necessary
• Diabetes medication if necessary, with follow-up by an endocrinologist
• Specific medicines (e.g. corticosteroids or immunosuppressants) may be indicated if you have autoimmune pancreatitis
• A consultation with a geneticist will be offered if necessary

In some cases, an intervention may be proposed: 

• Extracorporeal lithotripsy uses shock waves to fragment stones present in the pancreatic duct
• Endoscopy (endoscopic cholangiopancreatography) may help to further unblock the pancreatic duct by removing stones and placing small plastic tubes (stents) to keep the duct open
• Surgery may be necessary if part of the pancreas needs to be removed

What does follow-up involve?

Regular follow-up is essential to ensure that your care proceeds smoothly:

• At least one consultation per year with your gastroenterologist
• Blood tests at each visit
• An abdominal CT scan or magnetic resonance imaging every year
• A bone density scan every 2 years (or more often if necessary)

To make an appointment for a consultation, email ConsGastroMed [dot] erasme [at] hubruxelles [dot] be (ConsGastroMed[dot]erasme[at]hubruxelles[dot]be) or call +32 (0)2 555.35.04, or contact the H.U.B Gastroenterology Department directly at SecMed [dot] GastroMed [dot] erasme [at] hubruxelles [dot] be (SecMed[dot]GastroMed[dot]erasme[at]hubruxelles[dot]be).