digestive disorders
Chronic Pancreatitis
Treatment of Chronic Pancreatitis
Pain control Pancreatic enzyme supplements Management of diabetes The prognosis for chronic pancreatitis varies. Even if alcohol is not the cause, all people with chronic pancreatitis should avoid drinking alcohol and stop smoking. Pain control is the most challenging part of managing chronic pancreatitis, and treatments are focused on reducing pain and slowing disease progression. Eating four or five meals a day consisting of food low in fat may reduce secretion of pancreatic enzymes and reduce pain. Opioid Pain Relievers are sometimes needed to relieve the pain. Too often, pain relief measures do not relieve the pain, requiring increased amounts of opioids, which may put the person at risk of addiction. Doctors may recommend additional pain drugs, such as tricyclic antidepressants, Doctors may give corticosteroids to treat autoimmune pancreatitis. Sometimes doctors may use an endoscope (a flexible viewing tube) to carry out treatment. Endoscopic treatment with Endoscopic Retrograde Cholangiopancreatography (ERCP) may be used to drain a duct that is blocked by scarring (stricture), stones, or both. This procedure may provide pain relief. Stone removal (a procedure that involves the use of shock waves to break up stones) may be used to treat stones that are large or stuck in the pancreatic duct. Surgical treatment may be an option if the pancreatic ducts are dilated or if there is an inflammatory mass in one region of the pancreas. For instance, when the pancreatic duct is dilated, creating a bypass from the pancreas to the small intestine relieves the pain in about 70 to 80% of people. When the duct is not dilated, part of the pancreas may have to be removed. Removing part of the pancreas means that cells that produceinsulinare removed as well, and diabetes may develop. Doctors reserve surgical treatment for people who have stopped using alcohol and who can manage any diabetes that develops. Sometimes a pancreatic pseudocyst can cause pain as it expands and may have to be drained (decompressed) endoscopically or through the overlying skin. Pancreatic enzyme supplementation may reduce chronic pain by reducing the secretion of pancreatic enzymes. Although enzyme therapy is often tried because it is safe and has few side effects, it may not provide substantial pain relief. For people who have pancreatic insufficiency, taking tablets or capsules of pancreatic enzyme extracts with meals can make the stool less greasy and improve food absorption, but these problems are rarely eliminated. The supplements should be taken with meals. Doctors sometimes recommend people take a histamine-2 (H2) blocker or a proton pump inhibitor (drugs that reduce or prevent the production of stomach acid) with the pancreatic enzyme supplements. With pancreatic enzyme treatment, the person usually gains some weight, has fewer daily bowel movements, has no more oil droplets in the stool, and generally feels better. If these measures are ineffective, the person can try further decreasing fat intake. Supplements of the Fat-soluble vitamins (A, D, E, and K) also may be needed. (See also Treatment .) in the bloodstream causes low glucose (sugar) levels in the blood, which can result in a hypoglycemic coma (see Symptoms ). 