Pancreas

Chronic Pancreatitis

Long-standing inflammation leading to irreversible damage, pain, and loss of pancreatic function.

Overview

Chronic pancreatitis is progressive inflammation of the pancreas leading to irreversible structural damage, fibrosis, and loss of both exocrine (digestive enzymes) and endocrine (insulin) function. Dr. Bhagat presented a 7-year surgical experience on chronic pancreatitis at JSHBPS 2025 Japan.

Causes

Alcohol (60-70% of cases in India)
Idiopathic (20-30%)
Genetic mutations (SPINK1, CFTR, PRSS1)
Tropical pancreatitis
Autoimmune pancreatitis
Hypertriglyceridemia
Recurrent acute pancreatitis

Risk Factors

Alcohol use (>5 drinks/day for 5+ years)
Smoking (independent risk factor)
Family history
Recurrent acute pancreatitis
Male gender
Age 30-40 at onset

Symptoms

Recurrent severe upper abdominal pain radiating to back

Pain after eating

Steatorrhea (oily, foul-smelling stools)

Weight loss

New-onset or worsening diabetes

Nausea and vomiting

Malnutrition

Diagnosis

CT abdomen (pancreatic calcifications, ductal changes)
MRCP (ductal anatomy, strictures, stones)
Endoscopic ultrasound (early changes)
Pancreatic function tests
Blood glucose/HbA1c (for diabetes)
Fecal elastase (exocrine insufficiency)

Treatment Options

1Pain management (WHO pain ladder)

2Pancreatic enzyme replacement therapy

3Endoscopic therapy (stone extraction, stenting)

4Lateral pancreaticojejunostomy (Frey/Puestow procedure)

5Duodenum-preserving pancreatic head resection (Beger/Berne)

6Total pancreatectomy with islet autotransplantation

Surgical Treatment

Surgery is indicated for intractable pain, pancreatic duct obstruction, or suspected malignancy. Frey procedure (lateral pancreaticojejunostomy with coring of pancreatic head) is Dr. Bhagat's preferred approach for large-duct disease with head enlargement. For small-duct disease, total pancreatectomy may be considered. Surgical outcomes are excellent for pain relief (80-85%).

Recovery

Frey/drainage procedures: 7-10 days hospital stay. Lifelong pancreatic enzyme supplements. Pain relief in 80-85% at 5 years. Diabetes management may be needed. Alcohol abstinence is mandatory.

Prevention

Complete alcohol abstinence
Stop smoking
Early treatment of acute pancreatitis
Genetic counseling for familial cases
Low-fat diet
Manage hypertriglyceridemia

Frequently Asked Questions

Can chronic pancreatitis be cured?

The damage is irreversible, but surgery can effectively control pain (80-85% success) and prevent further deterioration. Alcohol cessation is the single most important factor in slowing progression.

Will I need enzyme supplements forever?

If exocrine insufficiency develops (steatorrhea, weight loss), yes — lifelong pancreatic enzyme replacement with meals is needed to digest food properly.

Expert Consultation Available

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