If you are diagnosed with chronic pancreatitis, it may be necessary for you to make some lifestyle changes.
Give up alcohol
The most important thing is to stop drinking alcohol. This will help prevent your pancreas from being damaged further and may also help to reduce the symptoms of pain.
You should tell your GP if you think that you may have problems quitting alcohol. They can refer you to specialist services that are designed to help people stop drinking alcohol.
Give up smoking
If you smoke cigarettes, you should also try to quit. While smoking does not cause chronic pancreatitis, it can speed up its progress, making it more likely that you will lose pancreatic function. Your GP will be able to refer you to a quit-smoking service.
You may also need to change your diet because your digestive system may be having problems digesting certain foods.
For most people with chronic pancreatitis, it is recommended that they eat a low-fat diet and eat six small meals a day rather than three large ones. Your GP will be able to provide you with appropriate dietary advice. Alternatively, they may refer you to a dietitian who will draw up a suitable diet plan.
You may also be given tablets that contain an artificial version of the enzymes that are produced by your pancreas in order to help improve the effectiveness of your digestive system.
The enzyme tablets should help to improve the symptoms of bloating and abdominal cramps, as well as making your stools less greasy and foul-smelling.
Pain relief is an important part of the treatment of chronic pancreatitis. Not only is chronic pain physically unpleasant, it can have adverse psychological effects, such as depression.
A step-by-step approach to pain relief is usually recommended, which means that your GP will first try painkillers that are less strong. If these don't work, they will 'step up' to more powerful painkillers.
Over-the-counter (OTC) painkillers may be effective in treating mild to moderate pain. More severe pain may require stronger, opiate-based painkillers.
There is a risk that you may become addicted to the more powerful opiate-based painkillers. To minimise this risk, only use the painkillers as instructed.
If your pancreas is damaged to such an extent that it is not producing enough insulin, you will develop type 1 diabetes. This means that you will need to have regular insulin treatment for the rest of your life in order to keep your blood sugar levels normal.
Insulin is usually administered using injections. Insulin tablets are not usually recommended because your digestive system may be unable to break the tablets down to release the insulin.
See Useful links for more information about the treatment of type 1 diabetes.
If you have severe, chronic pain that fails to respond to painkillers, surgery may be required. It is thought that severe chronic pain can develop for two reasons:
- Openings (ducts) in the pancreas can become blocked as a result of a build-up of calcium in the damaged tissue. The blocked ducts cause a build-up of digestive juices and this puts the ducts under an increased pressure, leading to pain.
- The top section of the pancreas, known as the head of the pancreas, can become inflamed. The inflammation can irritate the main nerve ending that runs out of the head of the pancreas.
In cases of chronic pancreatitis where the ducts are blocked, it may be possible to relieve the pressure on the ducts by widening them.
This can be done using an endoscope (a narrow, flexible tube) that is guided into your digestive system using an ultrasound scanner. A tiny balloon is passed down through the endoscope before being inflated in order to widen the duct. A tiny metal clasp, known as a stent, may then be used to keep the duct widened.
In cases where the head of the pancreas has become inflamed, and it is thought that the inflammation is irritating the nerve, the head of the pancreas can be surgically removed. This type of surgery is known as a pancreas resection.
Removing the head of the pancreas can also reduce pressure on the ducts. A pancreas resection can therefore be used if the results of the endoscopic treatment was ineffective.
The advantage of only removing the head of the pancreas is that the rest of the pancreas can often maintain its functions of producing insulin and digestive juices.
There are a number of different techniques that can be used to carry out a pancreas resection. Three widely used techniques are:
- the Beger procedure,
- the Frey procedure, and
- a pylorus-sparing pancreaticoduodenectomy (PPPD).
The Beger procedure
This procedure is used to treat inflammation of the pancreas head. The inflamed tissue is removed and the rest of the pancreas is reconnected to the intestines.
The Frey procedure
The Frey procedure can be used to treat cases where there is evidence that the ducts of the pancreas have become blocked and the head of the pancreas has become inflamed.
The inflamed part of the head is removed and then ducts are directly connected to the intestines, allowing the digestive juices to flow into the intensities.
Pylorus-sparing pancreaticoduodenectomy (PPPD)
A pylorus-sparing pancreaticoduodenectomy (PPPD) is usually recommended to treat the most severe cases of chronic pain, where there are both blocked ducts and inflammation of the head of the pancreas.
During a PPPD, the head of the pancreas is removed along with the gall bladder and bile ducts. The rest of the pancreas is then reconnected to the stomach.
Results of pancreas resections
Each type of surgery has its own advantages and disadvantages. PPPD seems to be the most effective technique in terms of reducing pain and preserving the function of the pancreas.
Possibly because it is the most complex of the three techniques, PPPD carries an increased risk of complications, such as infection and internal bleeding.
The Beger and Frey procedures carry a lower risk of complications, and have faster recovery times and less post-operative pain compared with PPPDs. However, they may not be as effective in providing long-term pain relief and preserving the function of the pancreas.
Before deciding on a surgical procedure, you should discuss the pros and cons of each technique with your surgical team.
In the most serious cases of chronic pancreatitis, where the pancreas has been extensively damaged, it may be necessary to remove the entire pancreas. This type of surgery is known as a total pancreatectomy.
A total pancreatectomy can be very effective in treating the symptoms of pain. It carries the obvious disadvantage that your pancreas will no longer be able to produce the insulin that is needed by your body.
Autologous pancreatic islet cell transplantation (APICT) is a relatively new technique that attempts to overcome this disadvantage.
Autologous pancreatic islet cell transplantation (APICT)
During APICT, special cells, known as islet cells, are removed from the pancreas. Islet cells are responsible for producing insulin.
The pancreas is then surgically removed from the body. At the same time, the islet cells are mixed with a special solution, which is then injected into the liver. If the APICT procedure is successful, the islet cells will remain in the liver and will begin to produce insulin.
In the short-term, APICT appears to be effective, but you may require additional insulin treatment in the long term.
See Useful links for more information about APICT.