Pancreatitis, chronic

Treating chronic pancreatitis

Lifestyle changes

If you are diagnosed with chronic pancreatitis, you will need to make some lifestyle changes. These are described below.

Alcohol

The most important thing is to stop drinking alcohol. This will help prevent your pancreas from being damaged further and it should also help to reduce the pain.

If you continue to drink alcohol it is likely that you will experience debilitating pain and you will be three times more likely to die from a complication of chronic pancreatitis.

Some people with alcoholic chronic pancreatitis will have a dependency on alcohol and will require additional help and support to stop drinking. If this applies to you, talk to your GP about getting help to stop drinking.

Treatment options for alcohol dependence include:

See Alcohol misuse - treatment for more information.

Quitting smoking

If you smoke cigarettes, try to give up. Smoking can speed up the progress of chronic pancreatitis, making it more likely that your pancreas will lose its function.

It is recommended that you use an anti-smoking treatment, such as nicotine replacement therapy (NRT) or bupropion (a medication that is used to reduce cravings for cigarettes). People who use these types of treatments have a much greater success rate in permanently stopping smoking than those who try to quit using willpower alone.

If you want to give up smoking, it is a good idea to start by visiting your GP. They will be able to provide you with help and advice about quitting and can refer you to an NHS Stop Smoking support service.

These services offer the best support for people who want to give up smoking. Studies show that you are four times more likely to give up smoking if you do it through the NHS. For more information, you can call the NHS Smokeline on 0800 84 84 84.

You can also see the Health A-Z topic about Smoking - quitting  for further information and advice.

Dietary changes

The dietary advice for people with chronic pancreatitis is much the same as for people without the condition. Eat a healthy balanced diet that is low in fat, including plenty of fresh fruit and vegetables (five portions a day) and whole grains.

Your GP will be able to provide you with appropriate dietary advice. Alternatively, they may refer you to a dietitian who will draw up a suitable dietary plan.

You may also be given medication that contains an artificial version of the enzymes that are produced by your pancreas to help improve the effectiveness of your digestive system. This type of medication is known as pancreatic enzyme supplements.

Side effects of pancreatic enzyme supplements include:

If you do experience side effects that are particularly troublesome then you should talk to your GP as your dosage may need to be adjusted.

Pain relief

Pain relief is an important part of the treatment of chronic pancreatitis. Not only is chronic pain physically distressing, it can also lead to depression.

A step-by-step approach to pain relief is usually recommended. This means that your GP will first try using painkillers that are not too strong. If these do not work, they will move to more powerful painkillers.

The first painkiller that is usually used is paracetamol or a non-steroidal anti-inflammatory drug (NSAID) type of painkiller, such as ibuprofen.

Taking NSAIDs on a long-term basis can increase your risk of developing stomach ulcers, so you may be prescribed an additional medication called a proton pump inhibitor (PPI). This can help protect against stomach ulcers.

See Stomach ulcers - treatment for more information.

If NSAIDs or paracetamol prove to be ineffective in controlling your pain, it is likely that you will require a stronger opiate-based painkiller, such as codeine or tramadol. Side effects of these types of medication include:

  • constipation
  • nausea
  • vomiting
  • drowsiness

The side effect of constipation can be particularly troublesome if you need to take an opiate-based painkiller on a long-term basis. In such circumstances, your GP may prescribe a laxative for you to help relieve your constipation. See Constipation - treatment for more information.

If you feel drowsy after taking an opiate-based painkiller you should avoid driving and using heavy tools or machines.

In some cases, an additional medication called amitriptyline may be recommended. Amitriptyline was originally designed to treat depression, which can help because many people with chronic pain conditions also experience episodes of depression. In some people, amitriptyline can also help to relieve pain.

If you experience an attack of very severe pain, you may require a stronger opiate-based painkiller, such as morphine or pethidine. Side effects of these types of painkillers include:

  • constipation
  • dizziness
  • drowsiness
  • nausea
  • vomiting

Long-term use of these stronger opiate-based painkillers is not usually recommended because there is a high risk of addiction. Therefore, if you have persistent, severe pain, surgery will usually be recommended.

Surgery

Surgery can be used to treat what are thought to be the two most common causes of severe pain in chronic pancreatitis. These are described below.

  • Openings in the pancreas can become blocked as a result of a build-up of calcium in the damaged tissue. The blockage can lead to a build-up of digestive juices which places the openings under increased pressure and causes pain.
  • The top section of the pancreas, known as the head of the pancreas, can become inflamed. The inflammation can irritate the main nerve ending that runs from the head of the pancreas, triggering pain.

Endoscopic surgery

In cases of chronic pancreatitis where the openings are blocked, it may be possible to relieve the pressure by widening the openings.

This can be achieved using an endoscope (a narrow, flexible tube) that is guided into your digestive system using an ultrasound scanner. A tiny balloon is passed down through the endoscope before being inflated to widen the duct. A tiny metal clasp, known as a stent, can then be used to keep the opening widened.

The results of this type of surgery are not usually permanent and further treatment may be required.

An alternative approach is to use endoscopic surgery to drain bile out of a blocked opening. This can provide effective pain relief in most cases and the results are usually permanent.

Pancreas resection

In cases where the head of the pancreas has become inflamed, and it is thought that the inflammation is irritating the nerve, the head of the pancreas can be surgically removed. This type of surgery is called a pancreas resection.

Removing the head of the pancreas can also reduce pressure on the ducts. Therefore, a pancreas resection can be used if an endoscopic treatment proves to be ineffective. The advantage of only removing the head of the pancreas is that the rest of the pancreas can often still produce insulin and digestive juices.

There are several techniques that can be used to carry out a pancreas resection. Two widely used techniques are:

  • the Beger procedure (a variant of this procedure is known as the Frey procedure)
  • a pylorus-preserving pancreaticoduodenectomy (PPPD)

These are briefly described below.

The Beger procedure

The Beger procedure is used to treat inflammation of the pancreas head. The inflamed tissue is removed and the rest of the pancreas is reconnected to the intestines.

The Frey procedure

The Frey procedure can be used to treat cases where there is evidence that the ducts of the pancreas have become blocked and the head of the pancreas has become inflamed. The inflamed part of the head is removed and the ducts are directly connected to the intestines, allowing the digestive juices to flow into the intestines.

Pylorus-preserving pancreaticoduodenectomy (PPPD)

A pylorus-preserving pancreaticoduodenectomy (PPPD) is usually recommended to treat the most severe cases of chronic pain, where there are both blocked ducts and inflammation of the head of the pancreas.

During a PPPD, the head of the pancreas is removed along with the gall bladder and bile ducts. The rest of the pancreas is reconnected to the stomach or bowel.

Results of pancreas resections

All three surgical techniques above seem to have the same levels of effectiveness in terms of reducing pain and preserving the function of the pancreas.

Possibly because it is the most complex of the three techniques, PPPD carries an increased risk of complications, such as infection and internal bleeding.

The Beger and Frey procedures carry a lower risk of complications and have faster recovery times and less post-operative pain than PPPDs.

Before deciding on a surgical procedure, you should discuss the pros and cons of each technique with your surgical team.

Total pancreatectomy

In the most serious cases of chronic pancreatitis, where the pancreas has been extensively damaged, it may be necessary to remove the entire pancreas. This type of surgery is known as a total pancreatectomy.

A total pancreatectomy can be very effective in treating pain. However, your pancreas will no longer be able to produce the insulin that is needed by your body.

Autologous pancreatic islet cell transplantation (APICT) is an experimental technique that attempts to overcome this disadvantage.

Autologous pancreatic islet cell transplantation (APICT)

During APICT special cells known as islet cells are removed from the pancreas. Islet cells are responsible for producing insulin.

The pancreas is then surgically removed from the body. At the same time, the islet cells are mixed with a special solution which is injected into the liver. If the APICT procedure is successful, the islet cells remain in the liver and begin to produce insulin.

In the short-term, APICT appears to be effective, but you may require additional insulin treatment in the long-term. See the NICE guidance about autologous pancreatic islet cell transplantation for more information.

Last updated: 21 November 2012

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