What is the treatment for chronic pancreatitis?
The doctor treats chronic pancreatitis by relieving pain and managing the nutritional and metabolic problems. The patient can reduce the amount of fat and protein lost in stools by cutting back on dietary fat and taking pills containing pancreatic enzymes. This will result in better nutrition and weight gain. Sometimes insulin or other drugs must be given to control the patient's blood sugar. Treatment of repeated flare-ups of chronic pancreatitis is similar to that of acute pancreatitis. During a
flare-up, avoiding alcohol is essential. Avoiding all food and receiving only intravenous fluids can rest the pancreas and intestine and may relieve a painful flare-up. In addition, opioid analgesics are sometimes needed to relieve the pain.
Later, eating four or five meals a day consisting of food low in fat and protein and high in carbohydrate may help reduce the frequency and intensity of the flare-ups. The person also must continue to avoid alcohol. If pain continues, a doctor searches for complications, such as an inflammatory mass in the head of the pancreas or a pseudocyst (a collection of pancreatic enzymes, fluid, and tissue debris resembling a cyst but without the usual lining found in other types of cysts). An inflammatory mass may require surgery; a pancreatic pseudocyst that causes pain as it expands may have to be drained (decompressed).
Most people with chronic pancreatitis do not need surgery but an operation is sometimes needed. The common reason for surgery is for persistent bad pain that is not helped by painkillers or other methods. Improvement in pain occurs in about 7 in 10 patients who have surgery. The operation usually involves removing part of the pancreas. There are different techniques that remove different amounts of the pancreas. The one chosen depends on the severity of the illness, whether the pancreatic duct is blocked and on other factors. The pain recurs sometime in the future in some people who have an initial improvement with surgery. Various other surgical procedures may be advised if there is a specific problem that can be corrected. For example, removal of a large calcium stone that is blocking the main pancreatic duct. Another procedure that may help in some people is to 'stretch' wide a narrowed pancreatic duct to allow better drainage of pancreatic enzymes.Surgery may also be needed if a complication develops. For example, if a blocked bile duct or pseudocyst develops.