Disease Description (Causes and Symptoms)
- Definition summary: Chronic pancreatitis is a disease in which exocrine (digestive enzyme) and endocrine (insulin) function are impaired and the pancreatic duct becomes irregularly dilated due to long-term pancreatic inflammation and fibrosis.
- Main causes
- Alcohol consumption (most common)
- Smoking (increases the risk of chronic pancreatitis; associated with ~25% in some studies)
- Pancreatic duct obstruction (congenital abnormalities, surgery, trauma, etc.)
- Hypertriglyceridemia, hypercalcemia, hyperparathyroidism
- Autoimmune pancreatitis
- Hereditary causes (gene mutations), tropical pancreatitis (geographic factors)
- Brief pathophysiology: Recurrent inflammation → parenchymal destruction and fibrosis → pancreatic duct obstruction and increased pressure → damage to exocrine and endocrine cells → malabsorption of fat and diabetes
- Main symptoms
- Recurrent upper abdominal pain (epigastric or left upper abdominal area, radiating to the back, possibly worsening after meals)
- Steatorrhea, weight loss, nutritional deficiencies
- Diabetes may develop in the late stage due to decreased insulin secretion
- Some patients are asymptomatic and are diagnosed incidentally
- Key diagnostic points (brief)
- Blood tests: During the chronic phase, amylase/lipase levels may be normal or decreased (elevated during acute exacerbation)
- Imaging: Abdominal CT/MRI (inflammation, fibrosis, calcification, and differentiation from tumors); calcification may be observed on abdominal X-rays (22–60%)
- Functional tests: Evaluation of exocrine function (including fat absorption tests)
- Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are useful for pancreatic duct lesions or early diagnosis (ERCP is considered primarily for therapeutic purposes)
Treatment Methods
- Treatment goals: Relieve pain, preserve pancreatic exocrine and endocrine function, and manage complications
- Basic lifestyle management
- Complete abstinence from alcohol and smoking cessation are recommended (key to prevention and preventing recurrence)
- Low-fat diet, eating small amounts frequently, and adequate fluid intake
- Monitor body weight and stool characteristics (steatorrhea)
- Medication treatment
- Pain control: Stepwise treatment beginning with non-opioid analgesics, as needed (opioid analgesics should be used cautiously)
- Pancreatic enzyme preparations (for exocrine insufficiency): Taken with meals to assist fat digestion and help relieve pain
- If diabetes occurs: Insulin treatment is usually required (the main cause of pancreatogenic diabetes is insulin secretion deficiency)
- Endoscopic treatment
- Balloon dilation of strictures, stent insertion, and pancreatic stone removal through ERCP
- Large stones are removed after extracorporeal shock wave lithotripsy (ESWL)
- Endoscopic treatment improves pain in many patients (results vary among reports)
- Surgical treatment
- Pancreatic duct drainage surgery (opening the main pancreatic duct and connecting it to the jejunum) — primarily for drainage
- Pancreatectomy (distal resection, resection including the pancreatic head, etc.) — selected according to the extent of the lesion
- Total pancreatectomy may be considered in severe cases
- Indications for surgery: Pain that cannot be controlled with endoscopic or conservative treatment, complications (obstruction, bleeding, suspected tumor), etc.
- Precautions, risk of complications, and self-management
- Complications: Pseudocyst, bile duct/duodenal stricture, pancreatic ascites, hemorrhagic pseudoaneurysm, portal hypertension, malabsorption, diabetes, pancreatic cancer (the risk of malignant transformation is particularly increased in hereditary cases)
- Warning signs (visit a medical institution immediately): Acute worsening of pain, fever/jaundice, persistent vomiting, hematemesis/melena, fainting/hypotension
- Nutritional management: Consider supplementation with fat-soluble vitamins if fat absorption is reduced; consultation with a dietitian is recommended in cases of weight loss
Outpatient Visit Checklist (Items to Bring and Checklist)
- Documents/materials to bring
- List of currently used medications and supplements (including dosage and administration times)
- Previous medical certificates and surgical records (if available), and recent test results (blood tests; imaging: CT/MRI, ERCP/EUS images)
- Blood glucose records (if diabetes is suspected or diagnosed), and records of weight changes
- Bowel movement status over the past 1–3 months (whether steatorrhea is present and its frequency), and eating patterns (amount of fat consumed)
- Alcohol and smoking history (type, frequency, and most recent use)
- Information to record before the outpatient visit
- Location and severity of pain (pain score), time of onset and relationship to meals, factors that relieve or worsen the pain
- Amount of weight loss (kg or %), and whether fatigue or decreased appetite is present
- Previous treatments (pancreatic enzymes, analgesics, endoscopic treatment/surgery) and whether they were effective
- Examples of questions that may be useful to show the doctor during the outpatient visit (brief)
- "Based on my current imaging and test results, how do you assess the status of my exocrine and endocrine function?"
- "What are the possible causes of my pain, and what treatment options are available?"
Examples of General Questions to Ask the Doctor
- What are the expected effects and side effects of this medication (or enzyme preparation/analgesic)?
- Given my condition, what are the indications for and expected benefits/risks of endoscopic treatment or surgery?
- What dietary changes and nutritional supplements are needed to improve my nutritional status?
- If I develop diabetes, how should it be managed, and will I need insulin?
- How will the risk of complications (such as pseudocyst and pancreatic cancer) be monitored?
Examples of Disease-Specific Questions
- Based on my test findings (CT/MRI/ERCP/EUS), could you explain which of pancreatic duct stricture, calcification, or cyst is the main problem? What is the recommended order of treatment?
- At what dosage and how should I take pancreatic enzyme preparations with meals for them to be effective? (For example, how should they be taken when consuming fat-soluble foods?)
- (If hereditary disease is suspected) Please explain whether genetic testing is necessary even though no one in my family has a similar medical history, and what the results would mean.