Chronic Pancreatitis: What It Is, Symptoms, and Signs of Exacerbation

Chronic pancreatitis is a long-term condition in which the pancreas (an organ in the middle of the abdomen that is involved in digestion and produces insulin) is inflamed, becomes scarred, and is painful. It is not the same as acute pancreatitis, when the gland becomes inflamed suddenly.

What chronic pancreatitis is

In chronic pancreatitis, repeated episodes of inflammation lead to irreversible damage: the working tissue of the gland is replaced by fibrous tissue. Because of scarring, the organ cannot produce the required amount of digestive enzymes, and damage to the areas responsible for insulin leads to diabetes. There is no remedy that eliminates the disease itself: care is aimed at symptoms and the problems associated with them. Scarring usually worsens over time; giving up alcohol and smoking helps slow the damage.

Causes of the disease

The most common cause is alcohol: repeated attacks of acute pancreatitis against the background of continued drinking gradually lead to persistent scarring. Other factors: smoking; genetic features, including the gene associated with cystic fibrosis (in children this is the most common cause); autoimmune damage; congenital underdevelopment of the gland; certain medications, including some antibiotics and diabetes drugs; gallstones; blockage of the ducts; elevated blood triglyceride levels. Some cases remain without an established cause.

Symptoms of chronic pancreatitis

The main symptom is abdominal pain. It may be in the upper abdomen, just below the ribs, on one side or throughout the abdomen; constant or intermittent; severe or a dull, aching pain. It is relieved by sitting and leaning forward, and worsened after eating; pain may also be aggravated by alcohol, lasts from several hours to several days, and may radiate to the back. Exocrine insufficiency is distinguished separately — a lack of enzymes for digesting food.

Other manifestations:

• nausea and vomiting, diarrhea;
• foul-smelling, fatty, floating stool that is difficult to flush; pale-colored stool;
• bloating and increased gas formation;
• thirst and frequent urination;
• effortless weight loss, including with normal eating.

Such symptoms resemble manifestations of other diseases, such as irritable bowel syndrome or gallstones, so the diagnosis is confirmed by examinations.

Signs of pancreatitis exacerbation

No separate signs of exacerbation are identified in the sources: the symptoms are the same — abdominal pain, nausea, vomiting, diarrhea, weight loss. If they intensify or there is no improvement, you should consult a doctor. Sudden severe abdominal pain may be a sign of acute pancreatitis or another condition requiring inpatient care. An acute attack against the background of chronic pancreatitis is possible, and this is not the same as an exacerbation of the chronic form.

Chronic pancreatitis by itself is not a reason to call an ambulance; 103/112 — if sudden severe abdominal pain occurs: this may be a sign of acute pancreatitis or another condition in which inpatient care is needed.

How it is diagnosed: tests and imaging

There is no single test, and first the doctor rules out other causes of the symptoms: palpates the abdomen, checks for yellowing of the skin and eyes, weighs the patient, orders blood and stool tests, and asks about relatives with pancreatitis.

Laboratory indicators: elastase and fat in stool, blood amylase, lipase, and trypsinogen, IgG4 if autoimmune pancreatitis is suspected. Imaging: CT and ultrasound of the abdominal organs, endoscopic ultrasound, MR cholangiopancreatography. The methods show edema, scarring, calcifications, and other changes in the gland.

Complications and when to see a doctor urgently

Possible complications include impaired absorption of nutrients with weight loss and weakened bones (osteoporosis), type 3c diabetes, cysts (pseudocysts) that may become infected, bleed, or compress neighboring organs, blockage of the ducts and bile ducts with pain or cholecystitis, vitamin deficiency, and iron-deficiency anemia. An increased risk of pancreatic cancer is also noted. You should consult a doctor if symptoms appear, the condition worsens, or there is no improvement.

This material is for reference: it describes the signs and examinations in chronic pancreatitis and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer