Chronic pancreatitis is usually defined as a long-term chronic inflammatory process of the pancreas, characterized by irreversible morphological changes.
- Signs and symptoms
For most patients with chronic pancreatitis, the main symptom is abdominal pain. The patient experiences periodic attacks of severe pain, often in the middle of the abdomen or in the left upper abdomen, sometimes irradiating as a band or localized in the middle back. The pain may occur after eating or independently of eating, but it is not transient or transient and usually lasts at least several hours. Other symptoms associated with chronic pancreatitis include diarrhea and weight loss.
The diagnosis is based on the study of the structure and function of the pancreas.
Imaging studies such as abdominal radiography and CT scans may show inflammation or calcium deposits in the pancreas or changes in the pancreatic ducts. Pancreatic calcifications, which are often considered pathognomonic for chronic pancreatitis, are seen in approximately 30% cases.
Endoscopic retrograde cholangiopancreatography
Endoscopic retrograde cholangiopancreatography (ERCP) provides the most accurate visualization of the pancreatic ductal system and is considered the standard criterion for the diagnosis of chronic pancreatitis. It combines the use of endoscopy and fluorography to visualize and treat problems of the biliary tract and pancreatic ducts. See the image below.
Treatment is usually aimed at eliminating the underlying cause of pancreatitis and relieving pain and impaired absorption.
- Relief of pain
Pancreatic enzyme supplements may be helpful in reducing pain. The hypothesis is that stimulation of the pancreas by food causes pain. Cholecystokinin (CCK) is one possible mediator of this response. When exogenous pancreatic enzymes are taken with meals, the factors releasing CCK are degraded and the release of CCK in response to food intake is reduced. This reduces pancreatic stimulation and pain. If conventional medical therapy is ineffective and the patient has severe intractable pain, celiac blockade may be considered. This approach aims to alleviate pain by modifying the afferent sensory nerves in the umbilical plexus using agents that anesthetize, reduce inflammation, or destroy nerve fibers.
Endoscopic therapy aimed at decompressing a blocked pancreatic duct may be associated with pain relief in some patients. The rationale for this approach is based on the hypothesis that ductal hypertension due to narrowing of the main pancreatic duct leads to pain.