Which doctor treats pancreatitis - who to contact for acute and chronic forms. Symptoms and treatment of chronic pancreatitis

Health 12/24/2017

Dear readers, today on the blog we will talk about chronic pancreatitis. Unfortunately, this disease is now very common. In addition, the diagnosis is very young. As always, a doctor of the highest category, Evgenia Nabrodova, will tell you about the symptoms of the disease, possible complications and subtleties of treatment. I give her the floor.

Chronic pancreatitis is a long-term inflammatory process, which is accompanied by destructive changes in the organ and disruption of its secretory function. The disease develops after acute inflammation if the patient was not provided with medical care or the patient ignored the doctor’s recommendations regarding changes in lifestyle and diet.

Without treatment, the symptoms of chronic pancreatitis can lead to frequent relapses with acute pain and active destruction of the pancreas walls. The inflammatory process is also dangerous because malignant tumors can grow against its background.

Experts are very concerned about the trend towards an active increase in patients with chronic pancreatitis. If previously the disease was detected mainly after 50 years, today damage to the pancreas occurs in people 30-35 years old.

What provokes the development of chronic inflammation?

As with acute pancreatitis, chronic inflammation occurs most often against the background of alcoholism and. Alcohol has a toxic effect on the parenchyma, and the formation of stones promotes the penetration of infection from the bile ducts through the vessels directly into the pancreas. Alcoholic drinks greatly increase appetite, causing regular overeating. The combination of alcohol and rich fatty foods creates the preconditions for disruption of the functional activity of the gland and the progression of the chronic inflammatory process.

Predisposing factors include the following:

increased blood levels;
uncontrolled use of certain medications, including corticosteroids and estrogens;
autoimmune diseases;
chronic infectious and inflammatory diseases of internal organs;
constant nervous tension;
constant violation of the recommended diet, alcohol consumption.

The state of mind also affects the functioning of many digestive organs. Severe stress and constant nervous tension cause spasm of blood vessels and muscles, which are responsible for the promotion and use of pancreatic juice.

Features of the course of the disease

Outside the acute stage, the symptoms of chronic pancreatitis in adults are smoothed out; treatment does not require the use of analgesics and antispasmodics. Dull pain appears only when the diet is violated or overexertion. During an exacerbation, clinical manifestations are similar to those of acute pancreatitis. There is severe pain in the upper abdomen, which radiates to the left side of the ribs and the heart area. The skin and mucous membranes turn yellow. In the area of the projection of the gland, you can notice a lack of adipose tissue. Patients may develop red dotted spots on the skin of the body. With chronic inflammation, the abdomen is moderately swollen, palpation gives a reaction to pain, especially when pressing on the epigastrium and under the ribs.

Attacks of vomiting become more frequent, and the patient’s condition worsens because of this. Diarrhea or diarrhea may occur. Acute symptoms of chronic pancreatitis can last up to several days. During an exacerbation, damage occurs not only to the gland itself, but also to nearby organs. But the consequences of chronic pancreatitis may appear only after several years. Patients perceive the absence of frequent relapses as a cure and stop following the doctor’s recommendations. But if the disease progresses chronically, restrictions must be observed constantly. Otherwise, complications and regular exacerbations cannot be avoided.

This video describes the symptoms of chronic pancreatitis, which will help you detect the clinical manifestations of the disease in time and begin treatment.

What is the danger of chronic pancreatitis

Patients are often frightened not by the fact of developing pancreatitis, but by the appearance of acute and unbearable pain. Many people do not think about what happens to an organ during inflammation and how this can affect their overall health. The pancreas produces pancreatic enzymes, without which high-quality breakdown of foods and absorption of nutrients is impossible. But that's not the worst thing.

Pancreatitis is accompanied by self-destruction of the gland by its own enzymes. Enormous trauma to the mucous tissue occurs, which loses its functional abilities and may even become malignant in the future.

After the first inflammation, pseudocysts form. They accumulate pathological fluid and begin to compress surrounding tissues, leading, among other things, to disruption of the process of food movement through various parts of the gastrointestinal tract. Pseudocysts can fester. Due to a violation of the outflow of bile, obstructive jaundice occurs. The appearance of abscesses, parapancreatitis, retroperitoneal phlegmon, and internal bleeding is also possible.

If the patient does not undergo regular treatment, but is only afraid of the symptoms of exacerbation of chronic pancreatitis, without realizing the importance of all medical prescriptions, it will be difficult for specialists to take control of the disease and maintain a high quality of life for the patient.

Classification

The classification of chronic pancreatitis includes the following types:

primary (against the background of alcoholism, drug intoxication, metabolic diseases);
post-traumatic (due to gland injuries);
secondary (develops with gastrointestinal diseases, endocrine disorders).

Only a doctor can determine the type of chronic pancreatitis based on medical history and diagnostic data. The main examination methods are ultrasound and computed tomography of the abdominal cavity. A specialist can make a preliminary diagnosis based on the patient’s complaints. The patient notes increased pain after overeating, drinking alcohol and eating fatty foods. It is characteristic that many people experience exacerbations after festive feasts.

Chronic biliary pancreatitis develops mainly against the background of cholelithiasis, which causes inflammation of the pancreas in 25-90% of patients. The disease can occur for a long time with virtually no symptoms. Exacerbation of chronic biliary-dependent pancreatitis occurs mainly after migration of the stone along the biliary tract. Biliary colic occurs, which is difficult for patients to tolerate due to severe pain.

Chronic biliary pancreatitis is dangerous due to its complications. That is why experts recommend surgical treatment after the first recurrent colic. Symptoms of exacerbation of chronic pancreatitis may appear even after drinking a small amount of carbonated water, which causes spasm of the sphincter of Oddi. The patient's temperature rises sharply, nausea and vomiting occur, and bitterness appears in the mouth. The stone can completely block the papilla of Vater, leading to obstructive jaundice.

The biliary type of pancreatitis is accompanied by impaired carbohydrate metabolism (diabetes mellitus develops) and enzymatic insufficiency of the pancreas with severe disturbances in the functioning of all organs of the digestive system. The patient suffers from constant loose stools and increased gas formation. Even outside the phase of exacerbation of the disease, dyspeptic symptoms persist: belching, nausea, heartburn, severe loss of appetite. If you ignore the signs of chronic pancreatitis in adults, serious changes occur in the functioning of the organs of the entire digestive system, body weight begins to decrease, and the amount of absorbed vitamins and microelements decreases.

Women are more likely to suffer from gallstone disease. This is due to hormonal fluctuations in the body, repeated births, and estrogen intake. In this regard, specialists observe symptoms of chronic pancreatitis in women more often than in men. Pay attention to your heredity: if among your close relatives there are people with chronic pancreatitis and gallstones, adhere to simple dietary restrictions and never eat a lot of fried and fatty foods. Also be sure to limit alcohol, especially hard liquor.

When visiting a doctor, patients often ask the same question: “Can chronic pancreatitis be cured or will I have to follow a diet and take medications for the rest of my life?” For some reason, the need to comply with dietary restrictions for a long time greatly frightens people. But in fact, fatty and fried foods, which are contraindicated in chronic and acute pancreatitis, are also harmful for people without signs of digestive system diseases. If you give up unhealthy foods, the digestion of which takes a lot of energy and enzymes, you will begin to feel much better, ease of movement will appear, sleep will normalize, and your skin condition will improve.

Chronic pancreatitis occurs over a long period of time. You cannot grossly violate the diet even during prolonged remission. Many people with chronic pancreatitis, only by changing their diet, were able to put the disease into a long-term stage of remission and get rid of constant dull pain. Experts are well acquainted with such cases, confirming the importance of diet in inflammation of the pancreas and many other diseases of the digestive system.

Be sure to ask your doctor what you can eat if you have chronic pancreatitis, and what foods you should completely exclude from your diet. Usually a complete ban is imposed on fatty foods and alcohol. It is recommended to avoid frying any foods. It is better to boil, bake or stew them.

Treatment of chronic pancreatitis in the acute stage differs from treatment of the disease during remission. To relieve acute pain, analgesics and antispasmodics are used, detoxification therapy is carried out and the prevention of infectious complications is carried out, including antibacterial agents in the treatment regimen. The first day it is forbidden to eat. Hunger has a healing effect and relieves stress on the affected pancreas.

Correction of enzymatic dysfunction is carried out using enzymes. Additionally, somatostatin, protease inhibitors and other drugs are prescribed that reduce the effects of activation of pancreatic enzymes inside the gland.

Avoiding any alcoholic beverages is key in the treatment of chronic pancreatitis. Violation of this prohibition almost always leads to relapse of the disease and the development of complications.

Prevention and prognosis

When following medical recommendations and following a diet, chronic pancreatitis is mild and rarely worsens. The course of the disease largely depends on the actions of the patient himself. It is recommended to undergo a comprehensive examination several times a year so that the doctor can assess the condition of the digestive system and, if necessary, make adjustments to treatment. A sanatorium-resort stay according to its profile will not harm the patient. A gastroenterologist deals with the treatment and prevention of chronic pancreatitis. But if it is absent, you can contact a therapist or family doctor.

Chronic pancreatitis is a chronic, inflammatory disease of the pancreas with subsequent proliferation of connective tissue in it, developing under the influence of various causes, the result is the loss of production and secretion of pancreatic enzymes and hormones. As a result of a lack of enzymes (trypsin, amylase and lipase) of the pancreas, digestion (food processing) is disrupted and manifests itself in various symptoms. Chronic pancreatitis is characterized by periods of exacerbation (develops due to poor diet or alcohol abuse) and periods of remission (symptoms subside).

Chronic pancreatitis affects all age groups, female and male. In recent years, the trend towards this disease has increased, due to a decrease in the general standard of living and an increase in the number of people drinking low-quality alcohol. Women get sick more often than men, this is due to gallstone disease.

Physiology of exocrine pancreatic function

The exocrine function of the pancreas is understood as the ability to form and secrete enzymes (trypsin, amylase and lipase) of the pancreas. Enzymes are secreted by special secretory cells (pancreatocytes) of the pancreas and, together with pancreatic juice through the duct, are released into the duodenum. With the help of pancreatic enzymes, proteins, fats and carbohydrates included in food are digested; this process occurs in the stomach and small intestine. Each enzyme has its own function: lipase breaks down fats into fatty acids and glycerol, amylase breaks down carbohydrates into monosaccharides, trypsin breaks down proteins into peptides.

Causes of pancreatitis

The main mechanism for the development of chronic pancreatitis is an increase in pressure in the pancreatic duct and stagnation of pancreatic juice in it. Prolonged stagnation in the duct leads to disruption of its structure, as a result of which pancreatic enzymes easily penetrate into its own tissue, destroying its cells (autolysis) and the development of a chronic inflammatory process.

Chronic alcohol use	Alcohol abuse leads to the development of chronic pancreatitis. Under the influence of ethanol contained in alcohol, the sphincter of Oddi contracts (spasms) (it regulates the flow of pancreatic juice into the duodenum), resulting in stagnation of pancreatic juice in the gland's own duct. Alcohol also changes the composition of pancreatic juice, increasing the amount of proteins in it. As a result, proteins precipitate, forming so-called plugs in which calcium salts are deposited (they harden), which leads to blockage of the pancreatic ducts and stagnation of the produced juice. Stagnation, as noted above, leads to an inflammatory process;
Gallbladder diseases (cholelithiasis)	Inflammation of the gallbladder can lead to the development of chronic pancreatitis. Due to developmental anatomy, the gallbladder duct and pancreatic duct join together to form a common duct, which opens with one opening into the intestine. If a stone leaves the gallbladder and gets stuck in the common duct, the excretion of both bile and pancreatic juice is disrupted and an inflammatory process develops in both organs;
Enteritis, duodenal ulcer	Long-term inflammation of the duodenal mucosa affects the rate of outflow of pancreatic juice. Inflamed mucosa contributes to tissue swelling and difficulty in the outflow of pancreatic juice into the intestinal lumen. Also, chronic intestinal motility disorders interfere with the excretion of pancreatic juice.
Stomach ulcer	Can lead to chronic pancreatitis as a result of penetration (penetration) of the ulcer into the pancreas and destruction of its tissue;
Eating disorder	Eating fatty, spicy, fried foods creates additional stress on the pancreas. In this regard, it has to intensively produce enzymes necessary for digestion, which can have a damaging effect on the gland itself.
Congenital anomalies of the pancreas	As a rule, these anomalies are associated with changes in the lumen of the pancreatic duct. The outflow of pancreatic juice is disrupted (narrowing or cysts of the duct, irregular shape of the pancreas, and others);
Genetic mutations	Diseases such as cystic fibrosis and polycystic disease lead to hereditary pancreatitis
Venous congestion in the pancreas	As a rule, it occurs with heart or liver failure, leading to swelling and inflammation of its tissue
Infections affecting glandular tissue	Infectious mumps, tuberculosis. When the pancreas is infected, its function is disrupted, and the activation of digestive enzymes can occur in the gland itself, and not in the intestinal lumen, as it should be.
Taking toxic medications	Having a toxic effect on the pancreas, these drugs contribute to disruption of enzyme synthesis and inflammation of the gland itself.
The body produces autoantibodies	A malfunction of the immune system causes immune damage to the pancreas with the development of autoimmune pancreatitis. With this type of pancreatitis, the immune system itself fights against pancreatic cells and the components of pancreatic juice.

Symptoms of pancreatitis

	Description of the symptom and its cause
Pain	In chronic pancreatitis, it develops as a result of the following mechanisms: impaired outflow of pancreatic juice, insufficient oxygen supply to the gland as a result of its increased size (edema), inflammation of the nerve endings. Moderate pressing or burning pain is localized in the left side or in the left side with a transition to the back, “girdling pain.” More often it appears after 3-4 hours, after heavy consumption of fatty, fried, spicy foods or alcohol abuse. Pain subsides when fasting or bending the body forward in a sitting position.
Dyspeptic syndrome	It consists in the fact that the patient notes a number of symptoms: increased salivation, nausea, vomiting, bloating, diarrhea, belching, aversion to fatty foods. All these phenomena are caused by the fact that the pancreas cannot cope with its digestive function - there is enzymatic deficiency of the pancreas.
Metabolic disorders	Due to a lack of pancreatic enzymes, the process of breaking down the complex molecules of the food we consume into smaller ones that can be absorbed in the intestines is disrupted. In connection with this circumstance, with pancreatitis, even increased nutrition can be accompanied by a decrease in body weight, a lack of vitamins in the body, dry skin, brittle nails, a lack of iron in the body (anemia) and other symptoms.
Endocrine insufficiency	Damage to the pancreas, as a result of impaired insulin production, can lead to the development of diabetes mellitus
Fecal disorders	A lot of undigested food from the small intestine passes into the large intestine, where many bacteria live. Excessive supply of bacteria in the large intestine with nutrients leads to increased gas formation, diarrhea, and frequent bowel movements.

Complications of pancreatitis

Diabetes mellitus (as a result of insufficient production of insulin by the pancreas);
Cachexia (general exhaustion of the body), due to impaired absorption of all essential nutrients (the result of insufficiency of pancreatic enzymes);
Formation of abscesses (cavity with pus), cysts (as a result of chronic inflammation);
Left-sided pleurisy (inflammation of the pleura) or pneumonia, when the inflammatory process spreads to neighboring organs;
Atelectasis (collapse of lung tissue) of the lung, as a result of compression of the base of the lung by an enlarged, inflamed pancreas;
Splenic infarction develops as a result of compression of the spleen by an inflamed gland;
Pancreatic stones, more often with alcoholic pancreatitis;
Biliary hypertension (increased pressure in the gallbladder ducts) with the development of cholecystitis and hepatitis;
Infectious processes (peritonitis - inflammation of the peritoneum, septic conditions - infection in the blood, parapancreatitis - inflammation of the peripancreatic tissue) develop when the infection spreads beyond the pancreas;
Jaundice develops as a result of compression of the bile ducts;
Pancreatic cancer develops over many years in patients who do not take treatment, do not follow a diet, and have a genetic predisposition.

Diagnosis of pancreatitis

General blood analysis , is a non-specific method that reveals signs of inflammation:

The number of leukocytes may increase (>9*10 9);
increased erythrocyte sedimentation rate (>15mm/h).

Blood chemistry:

Decrease in total protein<60г/л, и альбуминов<35г/л; глобулины˃7-13%;
A sharp increase in amylase levels during an exacerbation (normal 28-104 U/l);
An increase in trypsin during exacerbation of chronic pancreatitis (normal 77 U/l);
Increased lipase during exacerbation of chronic pancreatitis (normal 105 U/l);
Increase in glucose>5.5 mmol/l;
Total cholesterol˂3 mmol/l;
Decrease in calcium level˂2.15 mmol/l.

Analysis of urine : testing urine for amylase content during an exacerbation of the disease, one of the main tests for determining pancreatitis:

Amylase (diastase) in urine increases during an exacerbation (the norm is 1-17 U/h).

Stool analysis (coprogram), detects pancreatic enzyme deficiency:

Creatorrhea - muscle cells in the feces, develops as a result of a lack of trypsin and impaired breakdown and absorption of proteins;
Amilorrhea - starch in the feces, occurs as a result of a lack of amylase and impaired digestion and absorption of carbohydrates;
Steatorrhea is fat in the stool that develops as a result of a lack of lipase and impaired breakdown and absorption of fats.

Functional tests to study the secretory function of the pancreas:

Test with cholecystokinin, normally the concentration of pancreatic enzymes increases, in chronic pancreatitis their concentration decreases;
Test with secretin, in chronic pancreatitis the production of water and bicarbonates by the pancreas is reduced; Normally, the test is positive (the production of bicarbonates and water increases in response to stimulation with secretin).

Ultrasound, detects cysts or calcifications in the pancreas, its uneven contours, changes in size, dilation of the pancreatic duct.
Endoscopic retrograde cholangiopancreatography, reveals dilation of the common bile duct and pancreatic duct.

Treatment of chronic pancreatitis

Treatment of chronic pancreatitis is carried out under the supervision of a doctor, with the appointment of individual treatment.
Groups of drugs used in the treatment of chronic pancreatitis:

Replacement therapy, is carried out with drugs containing pancreatic enzymes (Mezim, Creon, Pancreatin), in order to correct digestive processes (facilitate digestion), eliminate pain and bloating. These medications should be taken with meals. Take 1 tablet with meals.
Antacids(Phosphalugel, Almagel, Grastal) are prescribed to protect the duodenal mucosa from the acidic contents that are formed as a result of a lack of bicarbonates secreted by the pancreas. Almagel 1 tablespoon 3 times a day, 30 minutes before meals.
Antisecretory drugs(Famotidine, Omeprazole) are prescribed to neutralize the acid. Omeprazole 1 tablet (20 mg) 2 times a day.
Antispasmodics and analgesics(Nosh pa, Aspirin) are used for severe pain. Nosh pa 1 tablet 3 times a day.
Anti-inflammatory drugs(Diclofenac) reduce pain by reducing inflammation in the pancreas.
Reduction of active secretion of the gland, drugs (Octreotide, Sandostatin) are used for exacerbation of chronic pancreatitis, for severe pain syndrome that is not relieved by antispasmodics. Sandostatin 100 mcg 3 times a day, subcutaneously.
Prokinetics(Motilium, Cerucal) are used to suppress nausea and vomiting during exacerbation of chronic pancreatitis. Motilium 10 mg 3 times a day, 30 minutes before meals.

With long-term illness with chronic pancreatitis, endocrine disorders of the pancreas and the possible development of diabetes mellitus develop, so a mandatory consultation with an endocrinologist is necessary.

Diet for chronic pancreatitis

Elimination of factors that can provoke exacerbation of chronic pancreatitis (alcoholic drinks, smoking, coffee, fatty or fried foods, smoked foods, various sourdoughs, spicy foods, chocolate and others). Fish, mushroom or meat broths are prohibited. You need to eat small portions (no more than 300 g per meal), low-calorie foods, 5-6 times a day. Drink water that neutralizes acidity in the stomach (Borjomi, Essentuki No. 17). Limit daily fat intake to 60 g per day, carbohydrates to 300-400 g per day, protein to 60-120 g per day. Limit salt intake per day to 6-8 g.

If you have chronic diarrhea, exclude foods containing plant fiber (beans, peas, cabbage and others). Chopped or grated food must be steamed. You should not eat food that is cold or very hot. The diet uses foods that contain proteolytic enzyme inhibitors (potatoes, oatmeal, egg whites). Food should be mostly vegetarian (include various vegetables and fruits). Vegetable oils (coconut oil, soybean oil) are used for cooking. The diet includes vegetable and large soups (buckwheat, rice, oatmeal and others), low-fat dairy products (milk, kefir, low-fat cottage cheese or cheese). Meat and low-fat fish can be consumed during the period of remission (symptoms subside), rabbit meat, beef or chicken meat.

What is an approximate menu for chronic pancreatitis?

Pancreas This is a digestive organ that secretes special enzymes and hormones that help digest food and absorb nutrients.

The purpose of the diet for chronic pancreatitis:
ü Reduce irritation of the pancreas;
ü Eliminate symptoms of the disease (pain, bloating, nausea, loose stools, etc.);
ü Provide the body with necessary nutrients.

With chronic inflammation of the pancreas, the ability to digest and absorb fats is primarily reduced, which is manifested by abdominal pain and loose stools. Due to this basic principle when creating a menu is low fat content in the daily diet no more than 50 grams of fat per day.
Eating low-fat foods with optimal protein and carbohydrate content reduces the load on the pancreas, reduces inflammation and prevents further damage.

When creating a menu, a number of basic principles must be observed:

Principles	What's the point?
1. Low fat content up to 50 grams per day. In this case, the total amount of fat should be evenly distributed across all meals.	Reducing the load on the pancreas, the ability to process and absorb all fats. Eliminates pain, diarrhea, as well as impaired absorption of other substances.
2. Small amount of food up to 300-400 grams per dose. Other guidelines: The volume of food should not exceed the size of your fist or be guided by sensations; you need to eat so much food that you still want to eat at least the same amount.	The optimal amount of food allows the weakened pancreas to secrete a sufficient amount of enzymes to completely digest food. This reduces stagnation and fermentation of undigested food residues, which reduces bloating, pain, nausea and other unpleasant sensations.
3. Frequent meals 5-7 times a day.	Helps provide the body with all the necessary nutrients given the small amount of food consumed. Improves the protective properties of the mucous membranes of the digestive tract.
4. Food and drinks must be warm	Eliminates spasms, improves the release of digestive enzymes, improves the processes of breakdown of nutrients.
5. Avoid substances that overly irritate the pancreas and the mucous membrane of the digestive tract (alcohol, smoking, excessively fried, spicy, salty, smoked, etc.).	Helps restore pancreatic function. Reduces the risk of exacerbations and complications.

What products are preferable for chronic pancreatitis?

Product group	Featured	Should be limited
Meat, fish, eggs	Baked, boiled, stewed or steamed lean meat: veal, beef, rabbit, turkey, chicken (without skin), fish; canned tuna in its own juice, without oil, soft-boiled eggs, egg whites, steam omelet.	Fried, fatty meat, chicken with skin, animal organs (liver, etc.), duck, goose, fried eggs, bacon, canned tuna in oil, hot dogs, salami, sausages, smoked fish
Dairy	Low-fat or low-fat dairy products such as milk, cheeses, yogurt, sour cream.	Cream and cheese sauces, cream, fried cheese, high-fat dairy products, milkshakes.
Alternative products to meat and dairy products	Almond/rice milk and products made from them, soy products, tofu.	Coconut milk, nuts, nut butter, refried beans, fried tofu.
Cereals, bakery, cereals, legumes	Whole grains: bread (preferably yesterday's bread), couscous, low-fat crackers, noodles, pasta, rice, millet, barley, corn, oatmeal.	Cookies, croissants, French fries, fried potatoes or corn, chips, fried rice, sweet rolls, muffins, fresh bread, baked goods.
Fruits	Fresh, frozen, canned fruits. It is advisable to use heat-treated ones. Without peel, soft, sweetish, without coarse seeds.. For example: Sweet baked apples, bananas, blueberries. Tolerance to fruits in chronic pancreatitis is very individual.	Do not eat sour fruits and their varieties: lemon, cherry, red currant, etc. Avocados in limited quantities are high in fat. Melon, watermelon, small slices 1-2 per day. Avoid fried fruits. Limit grapes, especially those with seeds, gooseberries, plums, apricots.
Vegetables	Fresh, frozen and cooked. It is advisable to use heat-treated ones. Remove peel and large seeds. Pumpkin, carrots, beets, zucchini, potatoes.	Fried vegetables, cabbage, raw onions, bell peppers, radishes, radishes, garlic, spinach, sorrel, daikon, tomatoes, cucumbers, white cabbage, eggplant, green peas, baby beans.
Dessert	Apple sauce, puddings, sherbet, marmalade, a small amount of chocolate, honey, jam.	Pastries, cakes, sweets, pies, custard, donuts.
Beverages	Compote of dried fruits, decoction of dates, sports drinks, weak tea, mineral water Borjomi, Essentuki No. 17.	Drinks with cream, carbonated drinks, alcohol, kvass. Juices from citrus fruits, grapes.
Spices and seasonings	Green cardamom, cinnamon, nutmeg, vegetable oil/butter in small quantities, maple syrup, low-fat mayonnaise, mustard, salt, sugar (in limited quantities).	Lard, mayonnaise, olives, salad dressings, tahini paste.
Ø With low weight, You can use special supplements containing a special type of fat such as MTC Oil, middle-chain triglycerides. Pancreatic enzymes are not required for the absorption of these fats. These fats can be purchased in sports nutrition stores in the form of separate mixtures, or they can be found in coconut and palm kernel oil (Palm Kernel Oil). Add MTS Oil to food, 1-3 teaspoons per day. Food supplements such as Peptamen and Vital are also rich in such fats.

Daily menu containing 50 grams of fat

Eating	Products
Breakfast	Steam omelette from 1 egg with spinach (white); 1 whole grain toast with butter (less than 1 teaspoon); ½ cup oatmeal; ½ cup blueberries; Tea, coffee or dried fruit compote.
Snack	Fruit smoothie: 1 cup soy or almond milk whipped with 1 cup low-fat yogurt and 1 banana.
Dinner	Turkey and cheese sandwich: 2 slices whole grain bread, 80 grams turkey or chicken breast (protein); 1 slice of low fat cheese Boiled pieces of carrots or beets, ½ cup apple juice (non-acidic)
Snack	1 cup low-fat cottage cheese (protein); 1-2 baked apples;
Dinner	100 grams of lean fish (protein); 100-150 grams of cooked rice; 1-2 boiled carrots; Whole grain bun; 1 teaspoon butter; Weak tea or dried fruit compote.
Snack	3 breads (wheat-oat); ½ cup blueberries (or other recommended fruit); 1 cup milk with 1% fat (protein);
Try to add protein for every meal and snack (brisket, fish, egg whites, low-fat dairy products, soy, etc.). If diet alone is not enough to eliminate symptoms, you should take pancreatic enzyme replacement drugs (Mezim, Creon, Panreatin, etc.) before meals.

Important! Above were general principles of nutrition for chronic pancreatitis that are suitable for most people suffering from this disease. However, it is worth noting that each organism is individual, gender, age, race, genetics, stress, concomitant diseases, etc., so creating a menu is a particularly individual matter. First of all, you must listen to your body in order to choose a diet that your body best accepts. Everything requires a reasonable approach and a golden mean. Be sure to consult your doctor!

How to help yourself during an attack of pancreatitis?

The best way to help yourself is to consult a qualified specialist, as many diseases can have similar symptoms.

But if these symptoms are not repeated for the first time and you already know the diagnosis, you can take the following steps, which should help with an attack of chronic pancreatitis without causing harm.

Steps	What to do?	What's the point?
1. Reduce pain	Take a pain reliever. Tablet 500 mg Paracetamol. 1-2 tablets, up to 3 times a day. Important! Use with caution in elderly people, people with impaired liver and kidney function. Do not take more than what is written in the instructions.	The safest pain reliever for pancreatitis recommended by WHO is paracetamol. Paracetamol relieves pain, reduces inflammation, and reduces temperature.
2. Eliminate spasm	Take an antispasmodic Options: Tablet 40-80 mg Drotaverine(No-Shpa, Bespa, Biopsha, Droverin, etc.), or an antispasmodic from another group: Mebeverine (Duspatalin, Niaspam), Meteospasmil (2 in 1 antispasmodic and antifoam), etc. If it is possible to give an intramuscular injection, the effect will occur faster (Drotaverina, Papaverina).	The main symptom of exacerbation of pancreatitis is pain. The pain is caused mainly by spasm of the smooth muscles of the intestines and sphincters. Therefore, the prescription of antispasmodics is the most effective and at the same time safe way to eliminate pain. However, do not forget that such drugs lower blood pressure and people with low blood pressure should be careful when taking them.
3. Reduce stomach acidity	Take a gastroprotector, a drug that reduces the secretion of hydrochloric acid in the stomach Option: Proton pump inhibitors: Omeprazole, Lansoprazole, Pantoprazole, etc. 1 tablet is enough. You can add coating agents Maalox, Phosphalugel, etc.	By reducing the acidity in the stomach, the intestines and pancreas are less irritated, which reduces cramps, bloating and thus pain.
4. Reduce pancreatic secretion	Take enzyme preparations such as: Mezim 20000, Pangrol, Creon 40000. 2-4 tablets. It is important that the enzyme preparation contains a large number of proteases. (>25,000 units).	Taking a large amount of digestive enzymes from outside inhibits the production and release of the same enzymes from your own pancreas. The pancreas secretes powerful digestive enzymes that can process food, but can also damage itself. With pancreatitis, their uncontrolled release occurs, which causes damage to the gland tissue, exacerbating inflammation.
5. Relieve bloating	Take carminatives or defoamers. Option: Simethicone 2-4 capsules (Espumizan, Simethicone, etc.)	Bloating often increases the pain of pancreatitis. Bloating causes stretching of the smooth muscles of the intestines, to which pain receptors react. Also, excessive bloating disrupts transit through the intestines, which further aggravates stagnation and gas formation, and with it the symptoms of the disease.
6. Hunger, cold and peace	Do not eat anything during an exacerbation. Maintain bed rest.	Basic principles of treatment to help the inflamed pancreas “cool down”. However, fasting for too long, as recent studies show, can lead to disruption of the protective mechanisms of the digestive tract mucosa and the development of pathogenic flora, which can cause infectious complications in the pancreas. Therefore, you should return to nutrition after the symptoms subside, but you must follow a strict diet.

The above listed methods of assistance are designed for attacks of exacerbation of mild to moderate chronic pancreatitis. However, if after using these methods the symptoms do not decrease, but progress even more, you should immediately call an ambulance. Acute and progressive pain in the abdominal area is always a serious signal that should be responded to immediately.

How to relieve pain during exacerbation of chronic pancreatitis?

Eliminating pain in chronic pancreatitis is not an easy task, since scientists have not yet found the main mechanism of its occurrence. Therefore, various treatment methods are often not as effective. We will try to take a comprehensive approach to solving this problem. There are two leading theories of chronic pain in the world. neurogenic pancreatitis and the theory of excess pressure inside the ducts and pancreatic tissue. In this regard, the main modern principles of treatment are aimed specifically at eliminating these mechanisms.

The World Health Organization offers a stepwise approach to eliminating chronic pain. pancreatitis. The principle is to gradually prescribe drugs from the least analgesic ability until the desired effect occurs. Example: first, paracetamol is prescribed, if there is no effect, then they give a stronger substance like codeine, then tramadol, and so in cases of failure it comes to powerful narcotic drugs like morphine.

There are also surgical methods for treating pain, which are used in cases where pharmacological methods do not produce results.

How to help yourself at home, relieve pain without harming the body. First of all, you must be sure that this is definitely an exacerbation of chronic pancreatitis, otherwise you can erase the clinical picture of another disease and waste precious time. If you are not sure, do not self-medicate. If you have been diagnosed and this is not the first case, then you can use this recommendation.

Let's look at the main steps:

What to do?	Dosage	Effect
1. Take a Paracetamol tablet.	1 tablet - 500 mg, 1 dose 1-2 tablets, 3-4 times a day. Important! No more than 4 grams of paracetamol per day. Risk of severe liver complications. For the elderly and people with impaired liver or kidney function, the daily dose should be less than 4 grams per day.	Acts on the neurogenic mechanism of pain. It has an analgesic effect, reduces temperature, and reduces inflammation. Important! High safety profile when taken correctly. Unlike other non-steroidal anti-inflammatory drugs, it does not damage the mucous membrane of the digestive tract.
2. Take a No-Shpa tablet (or another antispasmodic).	1 tablet - 40 mg or 80 mg Per dose: 40-80 mg, 3-4 times a day. If possible, make an intramuscular injection with a 2% solution of Drotaverine (No-Shpa). You can take any other antispasmodics (drugs that relieve spasms).	Spasms are the leading component of pain in pancreatitis. The drug relieves spasms of the smooth muscles of the intestine, sphincters and ducts, improves outflow, which leads to a decrease in pressure in the ducts of the gland (intraductal theory).
3. Take the capsule Omeprazole (Lansoprazole, Pantoprazole, etc.).	1 capsule - 20 mg (omeprazole), 30 mg - (Lansoprazole); 1 capsule per day;	The drug reduces the acidity of the stomach thereby: 1) reduces intestinal irritation (spasms, pain) from hydrochloric acid coming from the stomach to the upper intestines; 2) The impaired ability of the pancreas to maintain an alkaline environment in the upper intestines, necessary for the activation of digestive enzymes, is compensated.
4. Take enzyme preparations (Mezim 20000 or other enzyme preparations).	Up to 4-8 tablets per dose. 3-4 times a day; It is important that the protease content in the enzyme preparation is high (> 25,000 units)	The administration of a large number of enzymes reduces the secretion of the pancreas, which helps reduce the pressure in its ducts. Thereby influencing the mechanism of pain formation. It is important that the medications you take are not in capsules. The effectiveness of tablet forms was higher in a number of world studies (USA, Germany).
5. Take Simethicone (Espumizan, etc.).	Per dose: 2-4 capsules; 2-3 times a day.	Excessive gas formation in the intestines stretches smooth muscles, causing pain.
6. Hunger. Hunger is necessary during an exacerbation, as soon as the symptoms subside, you can and even need to eat. The main thing is to stick to the right diet. Recent scientific studies have proven that prolonged fasting after an attack of pancreatitis can negatively affect the protective functions of the mucous membrane of the digestive tract, and this in turn leads to the proliferation of pathogenic microflora and may subsequently lead to complications in the pancreas.

If symptoms progress, do not hesitate, contact a specialist or call an ambulance.

What is reactive pancreatitis?

Reactive pancreatitis is an acute inflammation of the pancreas that occurs against the background of exacerbation of chronic diseases of the digestive tract.

The most common causes: cholelithiasis, biliary dyskinesia, cholecystitis, chronic hepatitis, cirrhosis of the liver, inflammation of the duodenum, gastritis, stomach and duodenal ulcers. Also, reactive pancreatitis can develop after surgery, trauma, endoscopic examination (example: retrograde pancreatography).

Reactive pancreatitis is a form of acute pancreatitis, so the symptoms of the disease are the same. Diagnosis and treatment also do not differ much from the basic principles of managing patients with acute pancreatitis.

Why does diabetes develop after pancreatitis?

The pancreas is an organ that has 2 main functions:
1. Exocrine (production and secretion of digestive enzymes);
2. Endocrine (production of hormones, insulin, glucagon, etc.)

Special areas called the islets of Langerhans are responsible for the production of hormones in the pancreas; they occupy only 1-2% of the entire gland. The islets contain specific beta cells responsible for the production of insulin. And insulin is the main hormone responsible for the penetration of glucose (sugar) from the blood into cells. If it is not there, then all the sugar remains in the blood, leading to damage to blood vessels, nerves and organs, which is how diabetes manifests itself.

Pancreatitis is an inflammation of the pancreas, which can lead to damage to the cells responsible for the production of digestive enzymes and the beta cells responsible for the production of insulin. Diabetes that develops after pancreatitis is called pancreatogenic. Thus, diabetes can be classified into:

Pancreatogenic diabetes - caused by disease of the pancreas (low levels of insulin in the blood).
Type I diabetes is caused by an autoimmune disorder when the body's own immune defense cells damage the beta cells of the pancreas (low insulin levels in the blood).
Type II diabetes, caused by metabolic disorders, the body's cell receptors lose sensitivity to insulin (high levels of insulin in the blood).

Diabetes can develop as a result of acute pancreatitis if most of the pancreatic tissue has been damaged. So it is against the background of long-term progressive (5-10 years) chronic pancreatitis, in which functional tissue is replaced by non-functional tissue (fibrous, calcium deposits). However, this gland has a high compensatory ability and disturbances in its function begin to appear only when more than 90% of the cells are damaged.

Why is pancreatitis often combined with cholecystitis?

The main reason lies in the anatomical relationship of the pancreas and gallbladder. Two systems for excreting digestive enzymes are combined into one and open into the intestinal cavity. The common bile duct connects with the common pancreatic duct, forming the common excretory duct, which opens into the intestinal cavity at the level of the duodenum. Such a close relationship explains the frequent combination of pathologies of these two organs. However, they are connected not only anatomically, but also functionally, performing a single function of splitting the food bolus. Many pancreatic enzymes are simply not active without bile components.

Example: The pancreatic enzyme lipase, which breaks down fats, simply will not work without the influence of bile. Likewise, the functionality of the gallbladder does not fully manifest itself without the normal functioning of the pancreas. For example, the secretion of bicarbonate by the pancreas helps reduce acidity in the duodenum, this is a necessary condition for the activation of enzymes, both the pancreas and the normal functioning of bile acids.

The main cause of acute pancreatitis around the world is gallstones, which form against the background of a long-term inflammatory process (chronic cholecystitis). The stone, entering the common duct, creates conditions for increasing pressure in the ducts of the pancreas, this leads to the fact that pancreatic juice with all its enzymes returns back to the gland, where they are activated. This leads to damage to the gland tissue and the development of an acute inflammatory process.

The close relationship of the two organs, both anatomically and functionally, also determines the approach to the treatment of a particular organ. Often treatment is ineffective, only because their relationship is not taken into account. The normal functioning of one organ cannot take place without the normal functioning of another if they are components of the same system.

Chronic pancreatitis is an inflammation of the pancreas tissue, which is accompanied by disruption of the internal structure of the organ, abdominal pain and digestive problems. Among all diseases of the gastrointestinal tract, the frequency of chronic pancreatitis ranges from 5.1 to 9%, and in the last few decades, the incidence of pancreatitis in our country has doubled 1.

Chronic pancreatitis is an insidious disease, largely due to its recurrent nature. Patients are often concerned about periods of exacerbation, accompanied by severe pain, nausea, and vomiting.

Where does chronic pancreatitis come from? What causes the disease and is it possible to fight it? Let's try to figure it out.

Symptoms of chronic pancreatitis

Symptoms of chronic pancreatitis may vary depending on the stage (remission or exacerbation), course and physical condition of the patient. The main signs of the disease are as follows:

acute pain without clear localization. Pain can be felt in the right hypochondrium, upper or middle abdomen and spread to the back. In many patients, pain occurs immediately after eating, especially if the diet contained fatty, smoked or spicy foods;
frequent loose stools are one of the main signs of indigestion. Digestive problems in chronic pancreatitis are caused by a lack of enzymes;
heaviness in the abdomen, nausea, which also indicate a lack of digestive enzymes;
increasing feeling of hunger, muscle tremors, weakness, cold sweat;
intoxication, manifested in fever, chronic fatigue, and a feeling of general malaise 2.

Causes of chronic pancreatitis

One of the most common causes of chronic pancreatitis is poor diet and unhealthy lifestyle. Constant overeating, abuse of fatty foods and alcohol cause blockage of the excretory ducts of the pancreas. Narrowed excretory ducts provoke the accumulation and premature activation of digestive enzymes. As a result, the pancreas actually begins to digest itself, and inflammation forms 3.

In addition, the following factors can lead to chronic pancreatitis:

ulcer of the duodenum, stomach and enteritis. Chronic inflammation of the mucous membrane of the gastrointestinal tract makes it difficult to secrete pancreatic juice, which often causes chronic pancreatitis;
cholelithiasis. After leaving the gallbladder, the stone causes blockage of the common duct and inflammation of the pancreas develops;
genetic predisposition;
toxic effects of drugs 4.

Diagnosis of chronic pancreatitis

Identifying chronic pancreatitis can be difficult due to the nonspecific clinical picture. Nausea, abdominal pain, digestive problems - these symptoms are characteristic of many diseases, for example, stomach ulcers or chronic cholecystitis. Therefore, identifying the disease may require a whole range of studies. Diagnosis of chronic pancreatitis may include:

external examination of the patient. Chronic pancreatitis may be indicated by bluish areas of the skin on the front and side walls of the abdomen. In some patients, bright red patches of skin on the chest and back become noticeable. Palpation may reveal pain in the left hypochondrium and the upper third of the abdomen;
a general and detailed blood test, which shows the presence of an inflammatory process, based on an increase in the concentration of leukocytes;
laboratory blood test to detect pancreatic enzymes;
ultrasonography. In some cases, ultrasound can be performed through the walls of the stomach and duodenum, which significantly increases the accuracy of the examination. This method is called endoUS and combines the possibility of endoscopic and ultrasound diagnostics of the gastrointestinal tract;
computed tomography: used to determine complications of pancreatitis associated with thickening of the pancreas 5 .

Exacerbation of chronic pancreatitis

Chronic pancreatitis may hardly manifest itself until the period of exacerbation. Relapse of the disease is usually associated with two main reasons:

alcohol consumption. Even a small amount of alcohol consumed can provoke the transition of the disease into the acute phase;
violation of the diet, overeating, a large number of fatty, fried, spicy dishes on the menu.

Other factors can also provoke exacerbation of chronic pancreatitis in adults, for example, chronic stress, physical fatigue, poisoning or the toxic effects of certain medications 6.

An exacerbation of the disease is manifested by the following symptoms:

attack of acute or dull pain in the hypochondrium. Painful sensations spread to the subscapular region or the entire back;
progressive diarrhea. In this case, the feces have a characteristic greasy shine. Undigested food remains are often observed in the stool;
the occurrence of specific bitterness in the oral cavity, nausea and loss of appetite;
whitish coating on the surface of the tongue;
weight loss 7.

Exacerbation of chronic pancreatitis in adults can last for one to two weeks. You cannot fight the disease on your own during this period: the best solution is hospitalization and constant monitoring by specialists.

Treatment of chronic pancreatitis

The answer to the question “how to cure chronic pancreatitis” remains open even for modern doctors. The treatment regimen is determined by the doctor for each individual case. The main thing is that therapy should be comprehensive, affecting the main cause of the disease.

Treatment of chronic pancreatitis includes:

immediate cessation of bad habits. Smoking and abuse of strong alcoholic beverages aggravate the inflammatory process and contribute to the subsequent development of the disease;
strict adherence to the diet. The daily diet should be free of fatty and spicy foods, salt and pure sugar. You should eat food often, in small portions. In case of exacerbation of chronic pancreatitis, therapeutic fasting is prescribed, which will help stop pancreatic secretion and relieve pain. After 1-3 “hungry” days, the patient is transferred to a special diet;
basic therapy. In this case, we are talking about taking the following type of drugs: antispasmodics and analgesics, antisecretory and detoxification drugs. Treatment is carried out under the supervision of a doctor with strict adherence to the instructions;
taking enzyme preparations that facilitate the digestion process in case of exocrine pancreatic insufficiency. An example of an enzyme preparation prescribed for chronic pancreatitis is Creon®;
taking anti-inflammatory and painkillers that improve the patient’s well-being;
herbal medicine, which can be prescribed during remission only as prescribed by a doctor 8.

What to do if an exacerbation of pancreatitis occurs suddenly, and the ambulance has not yet arrived? Before the doctors arrive, you need to lie down, try to relax your abdominal muscles as much as possible and apply a heating pad with cold water to the sore spot. You should not take painkillers or any other medications - this will interfere with correct diagnosis. And, of course, any food and drinks, even plain water, are strictly prohibited, because any food or liquid can cause increased pain 9 .

The drug Creon ® 10000 and Creon ® 25000 for chronic pancreatitis

Inflammation of the pancreas inevitably causes a deficiency of digestive enzymes, which is expressed in the form of abdominal pain, loose stools, and heaviness in the abdomen. For chronic pancreatitis, the drug Creon ® 10000 and Creon ® 25000 helps to compensate for the deficiency of these substances, normalizing the breakdown and absorption of food.

Creon ® 10000 and Creon ® 25000 differ from other enzyme products in their unique release form. The active substance of the drug - natural pancreatin - is contained in a large number of minimicrospheres enclosed in a gelatin shell. Quickly dissolving in the stomach, the shell releases hundreds of mini-microspheres, which are thoroughly mixed with food and simultaneously pass from the stomach into the intestines; in the intestines, mini-microspheres are activated, helping to break down and better absorb nutrients 10.

Enzyme therapy helps relieve some of the unpleasant symptoms of chronic pancreatitis, prevent vitamin deficiency in the body and improve overall well-being. Creon ® 10000 and Creon ® 25000 have a wide spectrum of action and can be used not only for pancreatitis, but also for other conditions accompanied by exocrine pancreatic insufficiency, for example, after surgery on the pancreas, chronic gastroduodenitis, duodenal ulcer, impaired organ motility digestive disorders (IBS), cancer.

The material was developed with the support of Abbott to increase patient awareness of health conditions. The information in the material does not replace the advice of a healthcare professional. Contact your doctor

1. Chronic pancreatitis. I.V. Mayev. Textbook, Moscow, VUMNTs, 2003.

2. Ivashkin V.T. A short guide to gastroenterology. / Edited by V.T. Ivashkin, F.I. Komarov, S.I. Rapoport. M.: LLC “Izd. house" M-Vesti, 2001.

3. Ivashkin V.T. et al. On the classification of chronic pancreatitis // Clinical medicine. 1990. - No. 10.

4. Maev I.V., Kazyulin A.N., Kucheryavyi Yu.A. Chronic pancreatitis. - M.: OJSC Publishing House "Medicine", 2005.

5. Degtyareva I.I. Pancreatitis. Kyiv: Healthy, 1992.

6. Komarov F.I., Grebne A.L. Chronic pancreatitis. //Guide to gastroenterology. 1996. - T.Z.

7. Korotko G.F. Regulation of pancreatic secretion. //Rus. magazine gastroenterol., hepatol. and coloproctol., 1999.

8. Minushkin O.N., Chronic pancreatitis: some aspects of pathogenesis, diagnosis and treatment. //Consilium medicum. Application. Vol. No. 1. 2002.

9. Okorokov A.N. Chronic pancreatitis. Diagnosis of diseases of internal organs. 2002. - T.1.

Chronic pancreatitis is a disease of the pancreas associated with constant damage to its tissues due to inflammation.

Chronic pancreatitis can occur in people of all ages, but men aged 45-54 years are most often affected. The prevalence of chronic pancreatitis among the adult population of Russia is 3-5 cases per 10,000 people.

The most characteristic symptom of chronic pancreatitis is recurring pain in the abdominal area, which can be intense. Other signs of chronic pancreatitis depend on the degree of damage to the pancreas and get worse over time. One of these symptoms is the formation of stools with a greasy, greasy sheen and a foul odor.

If the inflammation of the gland is short-term, they speak of acute pancreatitis. Repeated cases of acute pancreatitis associated with alcohol consumption can sooner or later lead to the development of chronic pancreatitis.

Alcohol abuse is the cause of 7 out of 10 cases of chronic pancreatitis. This is due to the fact that alcoholism has a repeated damaging effect on the pancreas over many years.

Less common reasons:

smoking, which increases the risk of alcohol-related pancreatitis;
problems with the immune system when it attacks the pancreas's own cells;
a genetic mutation due to which the functions of the pancreas are disrupted, which can be inherited.

In approximately 2 out of 10 cases, the cause of chronic pancreatitis cannot be determined.

Pancreas

The pancreas is a small, tadpole-shaped organ located behind the stomach below the chest. It performs 2 important functions:

the formation of digestive enzymes, which are used in the intestines to digest food;
the production of hormones, the main of which is insulin, which regulates the level of sugar (glucose) in the blood.

Treatment mainly focuses on lifestyle changes (see below) and pain relief. If you have severe, long-term pain that is not relieved by taking medications, surgery may be required. It has been noted that people who do not smoke and avoid alcohol tend to feel less pain and live longer than those who were unable to get rid of these bad habits after diagnosis.

In half of patients with chronic pancreatitis, the pancreas is so damaged that it cannot produce insulin, which leads to the development of diabetes. Patients with chronic pancreatitis are at increased risk of developing pancreatic cancer. Always see a doctor if you experience severe abdominal pain - this is an important sign that something is wrong.

Symptoms of chronic pancreatitis

Repeated attacks of abdominal pain are the most characteristic symptom of chronic pancreatitis. The pain usually occurs in the center of the abdomen or on the left side and can spread (radiate) to the back. Most patients describe their pain as dull and at the same time very strong. The pain lasts for several hours and sometimes days. Pain occurs after eating, often for no reason.

The described attacks may be accompanied by nausea and vomiting. As chronic pancreatitis progresses, attacks become more severe and frequent. In some cases, the pain persists between attacks, only changing its character to mild or moderate. This happens more often in people with pancreatitis who cannot give up alcohol despite their diagnosis. In contrast, people who quit alcohol and smoking may experience a reduction in the severity and frequency of pain episodes. Progressive chronic pancreatitis

Over time, with chronic pancreatitis, the pancreas loses the ability to produce digestive juices, which are necessary for breaking down food in the intestines. As a rule, this occurs years after the first manifestations of the disease. In the absence of digestive juices, fats and certain proteins are poorly digested, which leads to the appearance of foul-smelling, greasy stools that are difficult to flush away when the toilet is flushed. Other symptoms are also observed:

weight loss;
loss of appetite;
jaundice (yellowing of the skin and sclera);
thirst, frequent urination, weakness - symptoms of advanced diabetes.

Always see a doctor if you experience severe pain - this is an important sign that something is wrong. You will need a doctor's help if you develop jaundice. In addition to pancreatitis, jaundice has many other causes, however, in any case, it is a sign of improper functioning of the digestive system. You should also contact your doctor if you experience persistent (uncontrollable) vomiting.

Causes of chronic pancreatitis

Many causes of chronic pancreatitis have been studied, however, in no more than 2 out of 10 cases they cannot be found. The most common factors leading to the development of chronic pancreatitis are discussed below.

In at least 7 out of 10 cases, the development of pancreatitis is associated with alcohol intake, especially long-term alcohol abuse. Alcohol intake causes episodes of acute pancreatitis. Acute pancreatitis usually goes away quickly, but when repeated over and over again, under the influence of constant drinking, it causes irreparable damage to the pancreas. Frequent inflammatory processes in the gland ultimately cause the development of chronic pancreatitis.

Regular alcohol consumption carries an increased risk of developing chronic pancreatitis, but fortunately only a few people develop the disease.

In rare cases, chronic pancreatitis is associated with a disease of the immune system, in which the immune system attacks the pancreas' own tissue. This disease is known as autoimmune pancreatitis, and its causes are not fully understood.

Autoimmune pancreatitis is often combined with other diseases when immune cells damage healthy tissue. For example, Crohn's disease or ulcerative colitis, which are associated with inflammation in the digestive system.

Sometimes chronic pancreatitis is inherited. It is believed that the cause of hereditary forms of the disease are mutations (changes) in a number of genes, including the PRSS1 and SPINK-1 genes. These mutations interfere with the normal functioning of the pancreas. There is evidence that in some people, due to genetic mutations, pancreatic cells become more vulnerable to alcohol.

Other, rarer causes of chronic pancreatitis have been identified:

pancreas injury;
blockage or narrowing of the pancreatic ducts;
smoking;
radiation therapy to the abdominal area.

Diagnosis of chronic pancreatitis

The final diagnosis of chronic pancreatitis can be established only after instrumental studies. But first, the doctor asks about complaints and conducts a simple examination. If, based on the results of the examination, he suspects chronic pancreatitis, an additional study is prescribed to confirm the diagnosis.

Tests that may be prescribed for you:

ultrasound examination (ultrasound), during which sound waves create a picture of the internal structure of the pancreas;
computed tomography (CT) - this study uses a series of X-rays to create a more accurate, three-dimensional image of the organ; endoscopic ultrasonography (see below);
magnetic resonance cholangiopancreatography or MRCP (see below).

During endoscopic ultrasonography, a flexible telescopic tube (endoscope) is passed into the stomach through the mouth, at the end of which there is an ultrasound transducer. Being in close proximity to the pancreas, the sensor allows you to create a highly accurate image of the organ and its structure. During the procedure, a sedative (calming) drug is usually given to help you relax.

To obtain a clearer image of the pancreas and nearby organs such as the liver and gallbladder on an MRI scanner, a contrast agent must be injected before MRCP. An MRI scanner uses magnetic field energy and radio waves to create detailed images of internal organs. MRCP allows us to evaluate whether gallstones are the cause of chronic pancreatitis.

Sometimes the symptoms of chronic pancreatitis and pancreatic cancer are very similar. Therefore, when jaundice (yellow coloration of the skin and whites of the eyes) and weight loss appear, a biopsy is prescribed to exclude a malignant neoplasm in the gland. A biopsy involves taking small samples of pancreatic cells and sending them to a laboratory, where they are examined under a microscope to look for cancer cells.

To take a biopsy, a long, thin needle is inserted into the site of the suspected tumor through the abdominal wall. To monitor the accuracy of needle insertion, ultrasound or computed tomography is used. Alternatively, a biopsy may be performed during an endoscopic ultrasonography procedure (see above).

Treatment of chronic pancreatitis

It is not possible to cure chronic pancreatitis, but treatment can control the course of the disease and reduce the severity of symptoms. If you have been diagnosed with chronic pancreatitis, some lifestyle changes are recommended.

The most important thing you can do is to eliminate alcohol from your life, even if alcohol is not the cause of your pancreatitis. This will prevent further damage to the pancreas and reduce pain. Continued alcohol consumption increases the likelihood of excruciating pain and the risk of death from complications of chronic pancreatitis.

People with alcohol addiction need extra help and support to stop drinking. If this applies to you, talk to your doctor to help you find a way to combat your alcoholism. For the treatment of alcoholism the following is used:

individual consultations with a psychologist;
participation in self-help groups, such as Alcoholics Anonymous;
the use of medications that reduce cravings for alcohol.

If you are susceptible to this bad habit, then try to quit smoking. Smoking worsens the course of chronic pancreatitis, accelerating the dysfunction of the pancreas. Your doctor may recommend anti-smoking treatment, such as nicotine replacement therapy (NRT) or medications to reduce cravings for cigarettes. It is easier for people who use drug therapy to quit smoking than those who rely only on their own willpower.

Because chronic pancreatitis causes problems with digestion of food, you may need to make dietary changes, such as limiting the amount of fat in your diet. Your doctor will give you appropriate recommendations for changing your diet and, if necessary, refer you to a nutritionist.

Drug treatment of chronic pancreatitis

Enzyme preparations, containing artificial analogues of pancreatic enzymes are used to improve digestion. Side effects may include diarrhea, constipation, nausea, vomiting and abdominal pain. If a side effect develops, tell your doctor about it, as you may need to adjust the dose of the enzyme preparation.

Treatment with steroid (corticosteroid) hormones, which reduce inflammation that damages the structure of the pancreas, is prescribed in cases where the cause of chronic pancreatitis is problems with the immune system. However, taking corticosteroids for a long time can lead to complications such as osteoporosis (brittle bones) and weight gain.

Painkillers. An important component of treatment for chronic pancreatitis is pain relief. First, weak painkillers are prescribed. If they do not help, you have to use stronger drugs.

In most cases, the first painkiller prescribed is paracetamol or a drug from the group of non-steroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen. Long-term use of NSAIDs increases the risk of stomach ulcers, so you may also be prescribed proton pump inhibitors, which protect against this.

If NSAIDs or paracetamol do not relieve pain sufficiently, you will be prescribed an opioid (narcotic) pain reliever, such as codeine or tramadol. Side effects of this group of drugs include constipation, nausea, vomiting and drowsiness.

Constipation is especially difficult to tolerate during long-term treatment with opioid painkillers. In such cases, taking laxatives may help. Read more about treating constipation. If you feel drowsy after taking an opioid analgesic, avoid driving or operating machinery.

If you are experiencing severe pain, you may need an even stronger drug, such as morphine. Its side effects are similar to those of the aforementioned opioid painkillers. Long-term use of strong narcotic painkillers is not recommended, as it can cause physical dependence on the medication. Therefore, if you constantly experience severe pain, you will be offered surgical treatment.

In some cases, amitriptyline is prescribed as an additional treatment. This drug was originally created to treat depression, but may help relieve pain for some people.

If treatment is not effective, severe pain can be relieved with a nerve block. This procedure helps relieve the condition for several weeks or months. A nerve block is an injection (shot) that stops the pain signals sent by the pancreas.

Deterioration of condition

If there is a sudden increase in inflammation in the pancreas, hospitalization for a short time is necessary. Hospital treatment will include fluids given into a vein, nutritional support through a tube (tube), and additional oxygen supplied to the nose through special tubes.

Surgical treatment of chronic pancreatitis

Surgery may be used to treat severe pain from chronic pancreatitis. The choice of surgical technique in each case depends on the cause of the disease. Some of them are described below.

Endoscopic intervention. If pancreatitis is associated with blockage of the pancreatic ducts by gallstones, endoscopic treatment with lithotripsy is possible. Lithotripsy involves breaking the stones into smaller pieces using shock waves, which are then removed using an endoscope (a long thin tube equipped with a light source, a video camera and mini instruments at one end). This type of treatment provides some pain relief, but the effect of the surgery may not be permanent.

Pancreatic resection. In cases where parts of the pancreas are inflamed and causing severe pain, they can be surgically removed. This type of surgery is called pancreatectomy. Resection is used when endoscopic treatment is ineffective. The resection technique depends on which parts of the pancreas are to be removed. For example, some surgeries involve removing part of the pancreas and gallbladder at the same time.

As a rule, all types of resection have approximately the same effectiveness in terms of reducing pain and preserving pancreatic function. However, the higher the complexity of the operation, the greater the risk of complications, such as internal bleeding or infection, and the longer the recovery period after the intervention. Discuss the pros and cons of the methods with your doctors before deciding to have surgery.

Total pancreatectomy (complete removal of the pancreas). In the most severe cases of chronic pancreatitis, when most of the pancreas is damaged, the entire organ may need to be removed. This operation is called a total pancreatectomy (complete removal of the pancreas). This is a very effective way to get rid of pain. However, once your pancreas is removed, your body will no longer be able to produce the vital hormone insulin. To cope with this situation, a new technique called autogenous cell transplantation of the islet of Langerhans has been developed.

It consists in the fact that even before the pancreas is removed, the cells of the islets of Langerhans, which are responsible for the production of insulin, are removed from it. The cells are then mixed with a special solution and injected into your liver. If successful, the islet cells take root in the liver tissue and begin to produce insulin there. The transplant is effective in the short term, but you may need insulin treatment in the future.

Complications of chronic pancreatitis

Damage to the pancreas during chronic pancreatitis often leads to the development of complications in the future.

In approximately 50% of cases, chronic pancreatitis leads to the development of diabetes mellitus. This complication develops years after pancreatitis is diagnosed (usually it takes about 20 years before diabetes develops).

Diabetes occurs when pancreatic cells are no longer able to produce insulin, a hormone needed to break down glucose for energy. Main symptoms of diabetes:

frequent urination, especially at night;
weight loss and muscle mass.

If diabetes develops as a result of chronic pancreatitis, you will need regular injections of insulin to compensate for its lack in the body.

Any chronic illness, especially one associated with constant pain, can have a negative effect on emotional and mental health. In a study of patients with chronic pancreatitis, it was found that one in 7 people developed psychological and emotional problems: stress, anxiety or depression.

Another common complication of chronic pancreatitis is pseudocysts, which are cavities (bubbles) filled with fluid on the surface of the pancreas. Pseudocysts form in every fourth patient with chronic pancreatitis. In most cases, pseudocysts do not cause any symptoms and are an incidental finding on a CT scan (computed tomography). However, in some people pseudocysts cause:

bloating;
indigestion;
dull pain in the abdomen.

If pseudocysts are small in size and do not cause any symptoms, then treatment is not necessary. They usually disappear on their own. Pseudocysts larger than 6 cm in diameter that cause anxiety are subject to treatment. In such cases, there is a higher risk of cyst rupture, internal bleeding, or infection.

Treatment for a pseudocyst involves removing fluid from it using a needle inserted through the skin. An alternative is endoscopic drainage, where a thin flexible tube called an endoscope is passed through the mouth into the digestive system. Liquid is removed using special microtools.

Pseudocysts are sometimes treated by removing part of the pancreas using a minimally invasive procedure called laparoscopic distal pancreatectomy.

Chronic pancreatitis is associated with an increased risk of developing pancreatic cancer. However, in general, this risk is not great. It is believed that pancreatic cancer will occur in only 1-2 people out of 100 patients with chronic pancreatitis. The most common initial manifestations of pancreatic cancer are almost the same as pancreatitis. These include jaundice, abdominal pain and weight loss.

Which doctor should I contact for chronic pancreatitis?

Using the NaPopravka service you can find a good gastroenterologist who treats chronic pancreatitis. If you can't see a specialist, find a general practitioner, such as an internist or family doctor.

Exacerbation of chronic pancreatitis is usually treated in gastroenterology departments of hospitals and specialized gastroenterology clinics. After reading the reviews, you can choose them yourself by following the links.

If surgery is required, find a good abdominal surgery clinic or

– a progressive inflammatory-destructive lesion of the pancreas, leading to disruption of its external and intrasecretory function. With exacerbation of chronic pancreatitis, pain occurs in the upper abdomen and left hypochondrium, dyspepsia (nausea, vomiting, heartburn, bloating), yellowness of the skin and sclera. To confirm chronic pancreatitis, a study of digestive gland enzymes, ultrasound, RCP, and a biopsy of the pancreas are performed. The basic principles of therapy include following a diet, taking medications (antispasmodics, hyposecretory, enzyme and other drugs), and if ineffective, surgical treatment.

General information

Chronic pancreatitis is an inflammatory disease of the pancreas with a long-term relapsing course, characterized by a gradual pathological change in its cellular structure and the development of functional failure. In gastroenterology, chronic pancreatitis accounts for 5-10% of all diseases of the digestive system. In developed countries, chronic pancreatitis has recently become “younger”; previously it was typical for people aged 45-55 years, but now the peak incidence in women is at 35 years of age.

Men suffer from chronic pancreatitis somewhat more often than women; recently, the proportion of pancreatitis due to alcohol abuse has increased from 40 to 75 percent among the factors in the development of this disease. There has also been an increase in the occurrence of malignant neoplasms in the pancreas against the background of chronic pancreatitis. A direct connection between chronic pancreatitis and an increased incidence of diabetes mellitus is increasingly noted.

Causes

Alcohol is a directly toxic factor for the gland parenchyma. In case of cholelithiasis, inflammation becomes the result of the transfer of infection from the bile ducts to the gland through the vessels of the lymphatic system, the development of hypertension of the biliary tract, or the direct reflux of bile into the pancreas.

Other factors contributing to the development of chronic pancreatitis:

persistent increase in the content of calcium ions in the blood;
hypertriglycerinemia;
use of medications (corticosteroids, estrogens, thiazide diuretics, azathioprine);
prolonged stasis of pancreatic secretion (obstruction of the sphincter of Oddi due to cicatricial changes in the duodenal papilla);
genetically determined pancreatitis;
idiopathic pancreatitis (of unclear etiology).

Classification

Chronic pancreatitis is classified:

by origin: primary (alcoholic, toxic, etc.) and secondary (biliary, etc.);
according to clinical manifestations: painful (recurrent and constant), pseudotumorous (cholestatic, with portal hypertension, with partial duodenal obstruction), latent (clinical unexpressed) and combined (several clinical symptoms are expressed);
according to the morphological picture(calcifying, obstructive, inflammatory (infiltrative-fibrous), indurative (fibro-sclerotic);
according to the functional picture(hyperenzyme, hypoenzyme), according to the nature of the functional disorders they can distinguish hypersecretory, hyposecretory, obstructive, ductular (secretory insufficiency is also divided according to the degree of severity into mild, moderate and severe), hyperinsulinism, hypoinsulinism (pancreatic diabetes mellitus);

Chronic pancreatitis is distinguished by the severity of the course and structural disorders (severe, moderate and mild). During the course of the disease, there are stages of exacerbation, remission and unstable remission.

Symptoms of chronic pancreatitis

Often, the initial pathological changes in the tissues of the gland during the development of chronic pancreatitis occur without symptoms. Or the symptoms are mild and nonspecific. When the first pronounced exacerbation occurs, the pathological disorders are already quite significant.

The main complaint during exacerbation of chronic pancreatitis is most often pain in the upper abdomen, in the left hypochondrium, which can become girdling. The pain is either severely constant or paroxysmal in nature. Pain may radiate to the area of the projection of the heart. Pain syndrome may be accompanied by dyspepsia (nausea, vomiting, heartburn, bloating, flatulence). Vomiting during exacerbation of chronic pancreatitis can be frequent, debilitating, and not bringing relief. The stool may be unstable, diarrhea may alternate with constipation. Decreased appetite and indigestion contribute to weight loss.

As the disease progresses, the frequency of exacerbations usually increases. Chronic inflammation of the pancreas can lead to damage to both the gland itself and adjacent tissues. However, it may take years for clinical manifestations of the disease (symptoms) to appear.

During an external examination, patients with chronic pancreatitis often notice yellowness of the sclera and skin. The shade of jaundice is brownish (obstructive jaundice). Pallor of the skin combined with dry skin. There may be red spots (“red drops”) on the chest and abdomen that do not disappear after pressure.

On palpation, the abdomen is moderately swollen in the epigastrium; in the area of the projection of the pancreas, atrophy of the subcutaneous fatty tissue may be noted. On palpation of the abdomen - pain in the upper half, around the navel, in the left hypochondrium, in the costovertebral angle. Sometimes chronic pancreatitis is accompanied by moderate hepato- and splenomegaly.

Complications

Early complications are: obstructive jaundice due to impaired bile outflow, portal hypertension, internal bleeding due to ulceration or perforation of the hollow organs of the gastrointestinal tract, infections and infectious complications (abscess, parapancreatitis, phlegmon of the retroperitoneal tissue, inflammation of the bile ducts).

Complications of a systemic nature: multiorgan pathologies, functional failure of organs and systems (renal, pulmonary, hepatic), encephalopathy, DIC syndrome. As the disease progresses, bleeding of the esophagus, weight loss, diabetes mellitus, and malignant neoplasms of the pancreas may occur.

Diagnostics

To clarify the diagnosis, the gastroenterologist prescribes laboratory tests of blood, stool, and functional diagnostic methods.

A general blood test during an exacerbation usually shows a picture of nonspecific inflammation. For differential diagnosis, samples are taken for the activity of pancreatic enzymes in the blood (amylase, lipase). Radioimmunoassay reveals an increase in the activity of elastase and trypsin. The coprogram reveals excess fat, which suggests pancreatic enzyme deficiency.

The size and structure of the pancreatic parenchyma (and surrounding tissues) can be examined using abdominal ultrasound, CT scan, or MRI of the pancreas. The combination of ultrasound and endoscopy - endoscopic ultrasonography (EUS) - allows you to examine in detail the tissue of the gland and the walls of the gastrointestinal tract from the inside.

For pancreatitis, endoscopic retrograde cholangiopancreatography is used - a radiopaque substance is injected endoscopically into the duodenal papilla.

If it is necessary to clarify the ability of the gland to produce certain enzymes, functional tests with specific stimulants for the secretion of certain enzymes are prescribed.

Treatment of chronic pancreatitis

Treatment is carried out conservatively or surgically, depending on the severity of the disease, as well as the presence or development of complications.

Conservative therapy

Diet therapy. Patients with chronic pancreatitis during periods of severe exacerbation are recommended to refrain from enteral nutrition; when constipation occurs, diet No. 5B is prescribed. In case of chronic pancreatitis, drinking alcohol is strictly prohibited; spicy, fatty, sour foods, and pickles are removed from the diet. For pancreatitis complicated by diabetes mellitus, control sugar-containing products.
Exacerbation of chronic pancreatitis is treated in the same way as acute pancreatitis (symptomatic therapy, pain relief, detoxification, relieving inflammation, restoring digestive function).
For pancreatitis of alcoholic origin, avoidance of alcohol-containing products is a key treatment factor, which in mild cases leads to symptomatic relief.

Indications for resection.

To prevent exacerbations of chronic pancreatitis, it is necessary to follow all the doctor’s recommendations on diet and lifestyle, and undergo regular examinations (at least 2 times a year). Sanatorium-resort treatment plays an important role in prolonging remission and improving the quality of life of patients with chronic pancreatitis.

Forecast

When following recommendations for the prevention of exacerbations, chronic pancreatitis is mild and has a favorable survival prognosis. If the diet is violated, alcohol intake, smoking and inadequate treatment, degenerative processes in the gland tissue progress and severe complications develop, many of which require surgical intervention and can be fatal.