What is Chronic Pancreatitis?
Chronic pancreatitis is a diseaseof the pancreas in which the pancreas gets progressively destroyed. It is seen in patients who consume alcohol or harbor stones. Sometimes, it runs in families and sometimes there is no reason to be found.
How do they present?
They present with recurrent pain in upper abdomen usually after meals, indigestion and sometimes diabetes.They may multiple hospital admissions for their pain.
What is the Treatment of Chronic Pancreatitis?
The treatment of chronic pancreatitis is done by medical, endoscopic and surgical methods. The main idea is to relieve pain, improve pancreatic function, and manage complications.
What are the Medical approaches to Chronic Pancreatitis?
They comprise of
- Analgesics for pain relief
- Pancreatic enzyme supplementation to aid in digestion and giving pancreatic “rest”.
- Avoiding Alcohol
- Nerve blocks under CT scan guidance- by injecting drugs that block pain-carrying nerves of the pancreas. Multiple sessions may be needed in this starategy.
- Endoscopy- Sometimes, the pancreatic duct can get narrowed that require dilatation with plastic pipes put during endoscopy (Stenting)
- Lithotripsy- Sometimes the pancreatic duct gets blocked by stones that need to be broken down by shock waves. This is called lithotripsy and is available in few centers. Both endoscopic stent and lithotripsy helps in restoring the flow of digestive juices.
When is Surgery done for Chronic Pancreatitis?
Surgery is usually reserved for people with chronic pancreatitis who have pain that does not respond to other treatments mentioned above.
It is reserved for patients whose CT/ MRI scan reports show dilated pancreatic ducts or a tumor/ cyst formation.
A surgical procedure called pancreaticojejunostomy relieves blockage and pressure in the pancreatic ducts. It alleviates pain in about 80 percent of people. The objective of the surgery is to relieve blockage by stones and narrowing and hence help in diminishing the pressure on the pancreatic cells. This, in turn, helps in restoring the flow of digestive juices and preventing cell damage. Sometimes, when a tumor like formation is seen in the head of the pancreas, its removal is also carried out- this is called “Coring”.
In the future, cell damage that produce diabetes may also benefit from “islet transplantation”.
How safe and effective is the Surgery for Chronic Pancreatitis?
This surgery is very safe with complication rates of less than 2%. The majority of the patients, when selected well have significant and sustained pain relief. In patients fulfilling the criterion, surgery should always be a strong option.