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Estimated by the Pancreas Foundation to occur in 50 out of every 100,000 people, chronic pancreatitis is inflammation of the pancreas that does not heal or improve, and it happens over the course of months or years. It can cause progressive destruction of the organ, resulting in life-limiting disease such as diabetes and enzyme deficiencies that impair the ability to properly digest food and make pancreatic hormones. Causes of chronic pancreatitis include the following:
- Heavy alcohol use, especially binge drinking
- Autoimmune conditions
- Blocked pancreatic duct or common bile duct
- Genetic mutations or family history
- Anatomic variants such as pancreas divisum
Chronic pancreatitis is more common in men and most often develops between the ages of 30 and 40.
Chronic Pancreatitis Symptoms
The most common symptom is abdominal pain. Unintentional weight loss is also common. Other chronic pancreatitis symptoms can include nausea, vomiting, diarrhea, and oily/fatty stools. As with many medical conditions, the earlier it is diagnosed, the sooner treatment can begin to prevent further damage and achieve a better outcome.
Diagnosing Chronic Pancreatitis
AdventHealth’s digestive health specialists use a number of modalities to diagnose chronic pancreatitis, including the following:
- Computerized tomography (CT) — a noninvasive x-ray that produces three-dimensional images that can reveal the extent of damage to the pancreas.
- Magnetic resonance cholangiopancreatography (MRCP) — uses magnetic resonance imaging (MRI) to produce cross-section images of the pancreas, gallbladder, and pancreatic and bile ducts.
- Endoscopic ultrasound — a nonsurgical test where a thin, flexible, lighted tube is inserted down the throat, through the stomach and into the small intestine. An ultrasound device is attached to the end of the scope that produces sound waves to create visual images of the pancreas and bile ducts.
Treating Chronic Pancreatitis
Prompt treatment of chronic pancreatitis upon diagnosis is imperative because ongoing inflammation can cause irreversible damage. It is a chronic disease that requires a comprehensive, long-term treatment plan involving a multi-disciplinary team of physicians as needed, including gastroenterologists, interventional endoscopists, endocrinologists and surgeons. The goal is to improve the patients’ quality of life as much as possible.
AdventHealth sees a high volume of chronic pancreatitis patients each year and was one of the top three hospitals in the state for the number of non-malignant pancreas disorders treated in 2017 as reported by the Agency for Healthcare Administration (AHCA). The treatment approach varies depending on the specific cause of a patient’s chronic pancreatitis but begins with trying the least invasive options first. These can include lifestyle and diet modifications as well as medications to control pain, enzyme replacements, and insulin if needed.
When medical therapy cannot provide sufficient relief, endoscopic or surgical intervention may be necessary. AdventHealth provides patients with access to minimally invasive options when possible, including the latest robotic surgical procedures. Some of the most common surgical treatments for chronic pancreatitis include the following:
- Pancreaticojejunostomy (Puestow procedure) — a surgical procedure that creates an artificial passage connecting the pancreas to the small bowel
- Pancreatic resections such as the Whipple procedure or distal pancreatectomies
- Pancreatitis divisum surgery — used to correct a congenital anomaly where the two ducts of the developing pancreas never fuse together
- Celiac plexus block procedure — an injection of a medication that stops the nerves in the abdomen from sending pain signals back to the brain
- Islet cell transplantation – islets with healthy beta cells are taken from the pancreas of a deceased organ donor to then inject the healthy islet cells into a person with type 1 diabetes through a vein that carries blood to the liver
AdventHealth also specializes in providing patients enhanced recovery after surgery (ERAS), a pathway designed to help them recover more quickly, leave the hospital sooner and experience fewer surgical side effects. A detailed, evidence-based protocol, it encompasses rest, adequate pain control, good nutrition and increased activity after surgery.
To schedule an appointment or refer a chronic pancreatitis patient to the AdventHealth Digestive Health and Surgical Institute.
Sebastian de la Fuente, MD, FACS, is board certified in general surgery with special certification in advanced surgical oncology. He specializes in surgical interventions for gastrointestinal, liver and bile duct diseases as well as for benign pancreatic disorders, pancreatic cancer, sarcomas and melanomas. One of Central Florida’s most prominent surgical oncologists, Dr. de la Fuente directs the Hepato-Pancreato-Biliary Fellowship program and serves as Director of Research for the Surgical Residency program at AdventHealth in Orlando. He is a graduate of Duke University’s general surgery residency program and capped his medical training with a fellowship in surgical oncology at the H. Lee Moffitt Cancer Center and Research Institute in Tampa.