What is chronic pancreatitis?

Chronic pancreatitis is a long-lasting condition that affects the pancreas. When someone has chronic pancreatitis, the pancreas becomes damaged over time due to repeated inflammation, resulting in permanent damage. This often manifests with abdominal pain, which is considered one of the most severe and debilitating types of pain. As the pancreas becomes scarred over time, it can’t produce enough enzymes to break down food. This leads to poor digestion, weight loss, and oily or greasy stools. Over time, the pancreas may also stop making enough insulin, which can cause diabetes.

It is usually discovered with images of your abdomen such as computed tomography (CT), magnetic resonance (MRI) or endoscopic ultrasound (EUS). These tests look at changes in the pancreas, but the results don’t always match how you feel or how well your pancreas is working.

Alcohol use. Long-term heavy drinking is the most common cause. It repeatedly irritates the pancreas, leading to inflammation, scarring, and lasting damage.

Smoking. Smoking is a strong risk factor. It worsens inflammation and speeds up pancreatic damage, especially when combined with alcohol use.

Genetic factors. Inherited mutations can increase the risk of pancreatitis, even without alcohol use or other triggers.

Recurrent acute pancreatitis. Multiple episodes of acute inflammation can gradually lead to permanent changes and chronic damage in the pancreas.

Severe acute pancreatitis. A single, very severe attack of pancreatitis causing tissue death can leave lasting damage, setting the initial stage for chronic pancreatitis.

Autoimmune pancreatitis. In this rare form of pancreatitis, the immune system attacks the pancreas by mistake, causing inflammation and scarring over time.

Obstruction of the pancreatic duct. Blockages from scar tissue or tumors can increase pressure inside the pancreas and cause inflammation, eventually damaging the pancreas.

Elevated triglycerides. Very high levels of triglycerides in the blood can trigger inflammation of the pancreas.

High calcium levels. Excess calcium in the blood can harm the pancreatic tissue and cause repeated inflammation, leading to chronic pancreatitis.

Idiopathic. Despite extensive work-up with currently available tests, many patients have chronic pancreatitis of unknown origin or better known as idiopathic chronic pancreatitis.

Abdominal pain is present in 80-90% of patients with chronic pancreatitis. This pain typically occurs in the upper belly, and can spread to the back, chest, ribs, lower left shoulder blade, or lower abdomen.  Pain varies widely in how it feels; it may be felt as throbbing, shooting, stabbing, sharp, cramping, aching, burning, or heavy. It can also be accompanied by sensations such as nausea, vomiting, or diarrhea. Pain can vary widely in severity, from being a mildly uncomfortable sensation to a debilitating condition. For some, the pain never fully goes away and is present all the time, though it may be stronger on some days. For others, the pain is not present all the time and comes as flares of variable intensity and duration. The pain may be triggered by eating or drinking. Pancreatitis pain can affect sleep, appetite, mood, and quality of life.

Chronic pain refers to pain that lasts for more than 3 months or more. It can affect only the belly or be widespread and affect multiple areas of the body. Acute pain comes on suddenly and is usually very severe. A common cause of acute pain is acute pancreatitis, which is acute inflammation and swelling of the pancreas. Acute pancreatitis can occur in patients with chronic pancreatitis and often needs treatment by a medical professional who will, administer you IV fluids, give you pain medications and rest your bowels.  In some cases, it might be managed at home if you can eat and drink, and your pain is controlled.

Alcohol use. Drinking alcohol can damage the pancreas further, even if you only drink occasionally or in small amounts. It can cause flare-ups of inflammation and lead to more frequent or intense episodes of pain. For many patients, the pain may improve after completely stopping alcohol

Smoking cigarettes. This increases inflammation and may speed up pancreatic damage, especially when combined with alcohol use. Smoking can trigger more pain, more frequent flare-ups, and a higher risk of developing pancreatic cancer. Just like with alcohol, even occasional smoking can be harmful.

Diet. High-fat foods like fried foods, creamy sauces, or greasy snacks, can trigger pain by forcing the pancreas to work harder. Large meals can also make pain worse, especially when eaten quickly or late at night

Exercise. Certain types of physical activity can trigger or worsen abdominal pain. Movements that involve bending, stretching the belly, or using the core muscles (like sit-ups or heavy lifting) may lead to discomfort during or after the activity

Environment. Changes in the environment, like hot, humid weather or cold temperatures can make the pain feel worse. Heat may lead to more body inflammation or dehydration, while cold can make muscles tense up, increasing pain. Stressful or noisy environments can also increase discomfort or make it harder to manage pain.

Skin contact and pressure. For some people with chronic pancreatitis, even light pressure or touch on the belly can trigger or worsen pain. This may include tight clothing, seatbelts, or even gentle touches.

Gather your doctor’s contact information. Put it on your fridge and in your phone. Know what phone numbers to use between appointments and ask what to expect when you call. For example:

• Does your doctor have a nurse you will speak with first?

• How quickly should you hear back?

• Do they have a 24-hour emergency call line?

• Some clinics have online messaging. Ask how long it takes for these messages to be addressed. Phone calls may have a quicker response in more urgent situations.

• Ask your doctor if you need to be seen immediately during pain flares.

  • If yes, will your doctor see you at the office or do you need to go to the emergency or urgent care?

• If your doctor is seeing you for a flare, what should you do if you are told the next appointment is several weeks away?

• Should you have blood tests and abdominal imaging during every flare?

  • If yes, what procedure should you follow to have these tests ordered and done quickly?

• How will you find out the results?

You should seek urgent medical attention at an emergency room for the following symptoms:

• Severe abdominal pain that that doesn’t improve with your usual medications.

• Intractable vomiting, without being able to keep any food or liquids down.

• Fever of greater than 100.5. Chills or shaking ("rigors") may also be signs of infection.

• Yellows tint of your eyes or skin.

• Stools that are black or bloody.

There is no cure for chronic pancreatitis. Even though the disease cannot be reversed, there are treatments that can help manage your symptoms (lifestyle changes, avoidance of triggers, pain medications, endoscopic and surgical procedures).