Chronic Pancreatitis

Dr Tan Yu-Meng
Director, Consultant General Surgeon

What Is Chronic Pancreatitis?

Chronic pancreatitis is a long-standing inflammation of the pancreas that alters its normal structure and functions.

This condition is characterised by the gradual replacement of healthy pancreatic tissue with fibrous scar tissue. As the amount of functional pancreatic tissue decreases, individuals may experience difficulties in digesting fats and proteins, leading to malnutrition and weight loss.

The progression of chronic pancreatitis usually develops over several years. It may present subtly with intermittent episodes of abdominal pain and progress to more severe and constant discomfort as the disease advances.

Causes and Risk Factors

These are the primary causes and risk factors associated with chronic pancreatitis:

Alcohol Consumption

Excessive alcohol intake is the most common cause of chronic pancreatitis in many countries. The risk of developing the condition increases with the amount and duration of alcohol consumption.

Smoking

Tobacco use is a significant risk factor for chronic pancreatitis. Smokers are at a higher risk of developing the condition compared to non-smokers.

Genetic Factors

Certain genetic mutations can predispose individuals to chronic pancreatitis. Familial cases of the condition suggest a hereditary component, which may result in the disease developing at a younger age.

Autoimmune Conditions

Autoimmune pancreatitis is a form of chronic pancreatitis caused by the body’s immune system attacking the pancreas.

Obstruction

Blockage or obstruction of the pancreatic duct due to stones, tumours, or strictures can lead to chronic pancreatitis by causing back pressure and damage to the pancreatic tissue.

Pancreatic Divisum

This congenital abnormality, where the ductal systems of the pancreas fail to fuse properly, can lead to repeated episodes of pancreatitis, eventually becoming chronic.

Symptoms

The hallmark symptom of chronic pancreatitis is persistent or recurring abdominal pain, which is often located in the upper abdomen and may radiate to the back. Other symptoms include:

  • Weight loss: This is due to the malabsorption of nutrients caused by a lack of digestive enzymes.
  • Steatorrhea: Fatty, foul-smelling stools that are a result of fat malabsorption.
  • Jaundice: Yellowing of the skin and eyes, which can occur if the bile duct becomes obstructed.
  • Diabetes: As the disease progresses, damage to insulin-producing cells can lead to diabetes.

Diagnosis

A detailed medical history and physical examination will be conducted first. Healthcare providers will usually enquire about the history of alcohol use, smoking, and symptoms experienced.

Blood tests can reveal elevated levels of pancreatic enzymes or changes indicative of pancreatitis. Stool tests may show high levels of fat, suggesting malabsorption.

Computed Tomography (CT) Scan: Provides detailed images of the pancreas, helping to identify inflammation, calcifications, or other changes.
Magnetic Resonance Imaging (MRI): Offers detailed images of the pancreas and surrounding structures, including the ductal system.
Endoscopic Ultrasound (EUS): Allows close examination of the pancreatic tissue and ducts. It can also be used to obtain tissue samples for further analysis.

Treatment

The management and treatment of chronic pancreatitis are multifaceted, aiming to alleviate symptoms, manage complications, and tackle the root causes where possible.

Non-Surgical Treatment

  • Pain Management: Effective pain control may involve analgesics or more potent medications, such as opioids, under strict medical guidance.
  • Enzyme Replacement: Pancreatic enzyme replacement therapy (PERT) can aid in digestion and alleviate malabsorption issues.
  • Diabetes Control: Managing diabetes through diet, medications, or insulin is essential for those whose pancreatic function has been compromised.
  • Nutritional Support: Dietary supplements or enteral nutrition might be necessary to address severe malnutrition.

Surgical and Endoscopic Treatments

  • Endoscopic Procedures: These can relieve obstructions in the pancreatic duct, reducing pain and improving drainage. Techniques include duct stenting and stone removal.
  • Surgical Resection: Part of the pancreas may be surgically removed to control pain or address areas of significant damage.

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Dr Tan Yu-Meng

Director, Consultant General Surgeon

Dr Tan continues to be one of few surgeons in Asia who perform specialized surgery for peritoneal malignancies in Asia.

  • MBBS (Bachelor of Medicine & Surgery, First Class Honors & Distinction at the University of London) 1994
  • RCSEd (Fellow of the Royal College of Surgeons Edinburgh) 1999
  • Further training in advanced HPB surgery and liver transplantation at the world renowned Liver Unit of Queen Elizabeth Hospital in Birmingham, United Kingdom.
  • Further training in living donor liver transplantation in Japan.

With his interest in gastrointestinal and hepatobiliary-pancreatic (GI-HPB) surgery and the treatment of cancer, Dr Tan joined the department of surgical oncology at the National Cancer Centre in 2003 as a consultant.

Dr Tan’s interest in the management of peritoneal surface malignancies was part of his effort in leading a multidisciplinary team from NCC to Washington Cancer Institute to adopt the techniques and protocols of peritonectomy and HIPEC (Sugarbaker procedure) from Dr Paul Sugarbaker in 2009.

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    Chronic Pancreatitis

    Frequently Asked
    Questions

    What are the possible complications of chronic pancreatitis?

    Complications can include pancreatic insufficiency, diabetes, pancreatic calcifications, pseudocysts, biliary tract obstructions, and an increased risk of pancreatic cancer.

    Can chronic pancreatitis be cured?

    While there is no cure for chronic pancreatitis, the condition can be managed through comprehensive treatment strategies to relieve symptoms and maintain quality of life.

    Are there any genetic tests for chronic pancreatitis?

    Genetic testing may be recommended for individuals with a family history of chronic pancreatitis or when a genetic cause is suspected, to identify specific mutations associated with the condition.

    How does chronic pancreatitis differ from acute pancreatitis?

    Chronic pancreatitis is a long-term condition characterised by irreversible damage to the pancreas, whereas acute pancreatitis is a sudden inflammation that typically resolves.