Treatment of Chronic Pancreatitis
- At the onset of the disease and if there are no complications, conservative treatment is recommended.
- The first few days, no food should be given to the patient. A special diet is then prescribed specifically designed for patients with chronic pancreatitis.
- In order to reduce the pain analgesics are given. When the pain is severe, opiates or procaine blockade is used.
- The excretory function of the pancreas is reduced by giving no food to the patient the first few days and by prescribing cholinolytics and antihistaminic drugs. Also, cold is applied locally.
- In order to restore protein balance, intravenous injections of plasma or plasma substitutes are administered.
- Antibacterial therapy is used by prescribing broad spectrum antibiotics including tetracyclines (since they are excreted very well by the pancreas).
- When the endocrine function of the pancreas is impaired or/and when the patient is suffering from malnutrition, insulin therapy is recommended. Anabolic drugs are also used in order to help the patient regain weight. Also, anabolic drugs reduce secretion of pancreatic enzymes. Chronic pancreatitis also usually leads to hypovitaminosis; therefore, A, C, E and B-group vitamins are prescribed.
- Pancreatic enzyme supplementation therapy is prescribed in order to ensure proper digestion of the food and to decrease the excretory function of the pancreas (to give it time to heal). However, if the excretory function of the pancreas is not impaired, pancreatic enzyme supplementation should not be prescribed. Also, many studies have shown that enzyme supplementation therapy does not reduce the pain associated with chronic pancreatitis.
The majority of patients that suffer from severe pain caused by chronic pancreatitis sooner or later require surgery to reduce the pain. Surgical treatment of chronic pancreatitis is very complex and should be tailored to the specific needs of the patient. It is also vital for the patient with alcoholic chronic pancreatitis to completely stop drinking alcohol. Regretfully, surgical treatment has very little positive effect if the person continues on drinking alcohol.
There are two reasons why patients who have chronic pancreatitis suffer from pain
- Obstruction of the pancreatic ducts – patients with chronic pancreatitis often have multiple areas of obstruction of pancreatic ducts, which causes severe pain. Opening up the pancreatic duct and directing the flow of the pancreatic juice into the small intestine considerably reduces the pain. This operation is called Peustow procedure.
- Inflammation of the head of the pancreas – is considered to be the main cause for pain in patients with chronic pancreatitis. The inflammation damages the pancreatic nerves, which can bring great suffering to the patient. The pancreatic head resection and Whipple operation are used to remove the affected portion of the pancreas in order to relieve the pain.
The following operations are used to reduce the pain of the patients with chronic pancreatitis:
- Peustow’s operation – during this operation the duct of the pancreas is opened all the way from the head of the pancreas to its tail. Then the small intestine is sutured to the duct, allowing for the pancreatic juices to be drained directly into the small intestine. This operation can be done by both the laparoscopic approach and open surgical approach.
- Pancreatic head resection – is a very complicated surgical procedure that is done to patients with severe chronic pancreatitis. During the operation only the head of the pancreas is resected, while the bile duct and duodenum are left untouched. The recovery time after this operation is much shorter than after Whipple operation, since bile ducts and duodenum are preserved. Pancreatic head resection is often combined with Peustow procedure, which offers the advantages of both procedures.
- The Whipple operation – only a small percentage of patients goes through Whipple operation. This operation can be performed through both laparoscopic and open surgical approach, though laparoscopic technique is preferred. During this operation the head of the pancreas, the gallbladder, a portion of the bile duct, and duodenum are removed. Sometimes a portion of the stomach is also removed. After this, the remaining bile duct, small intestine, and pancreas are sutured together to direct pancreatic secretions and bile into the intestine.