Brittle Diabetes Foundation

 

CHRONIC PANCREATITIS

 

Chronic pancreatitis is an ongoing, long term, inflammation of the pancreas that causes irreversible changes in the normal functioning and structure of the organ.

Diabetics generally understand the role the pancreas plays as an endocrine (hormone producing) organ, producing both insulin and glucagon. But what is often overlooked is the role it plays as a producer of digestive enzymes (the exocrine function) required for proper digestion of the foods we consume, in particular, fats.

If the pancreas is unable to make these digestive enzymes or the ducts through which these enzymes flow to the small intestine is blocked, it can lead to a condition referred to as EPI - exocrine pancreatic insufficiency. This results in an inability to breakdown food properly leading to malabsorption. At times duct blockage will cause these digestive enzymes to back-up leading to damage of the pancreas itself and depending on the cells affected could lead to diabetes or worse case scenario, brittleness.

Brittle or labile diabetes can result from the body’s inability to digest carbohydrates efficiently or when an inflamed or damaged pancreas plays havoc with insulin, glucagon and/or amylin production.  

The condition occurs more often in men than women and usually manifests itself in those between the ages of 30 and 40.

Symptoms include persistent abdominal pain, fatty stools resulting from the malabsorption of the fats in food , weight loss due to malabsorption, nausea, vomiting, and pain associated with food intake.

 

Causes

   Alcohol abuse over many years, gallstones, smoking, malnutrition, cystic fibrosis, hypercalcemia, idiopathic (unknown), inherited as an autosomal dominant trait, and/or blockage of the pancreatic duct.

 

Diagnosis includes symptomology followed by a variety of tests including fecal fat test, serum amylase, lipase, trypsinogen and IgG4.

Calcium deposition or changes to the duct system may be seen by CT scan, ultrasound, ERCP, EUS and MRCP.

 

Treatment includes pancreatic enzyme replacement therapy, analgesics including opiates to reduce pain, alcohol cessation, low fat diets, surgery – resectional or drainage procedures. When necessary, islet cell replacement therapy. Insulin is generally needed to treat resulting diabetes but needs to be monitored carefully because the patient may also exhibit decreased levels of glucagon the hormone that serves to balance the effects of insulin.