Treatment - Chronic pancreatitis

Treatment for chronic pancreatitis aims to help control the condition and reduce any symptoms.

Lifestyle changes

Avoiding alcohol

The most important thing you can do is stop drinking alcohol, even if it isn't the cause of your condition. This prevents further damage to your pancreas and may reduce the pain.

If you continue to drink alcohol, it's likely you'll experience pain that stops you carrying out your day-to-day activities and also be more likely to develop complications.

Some people with chronic pancreatitis have a dependency on alcohol and need help and support to stop drinking. See your GP if this applies to you.

Treatment for alcohol dependence includes:

• one-to-one counselling
• attending self-help groups – such as Alcoholics Anonymous
• taking a medicine, called acamprosate, that can reduce cravings for alcohol

Read more about treating alcohol misuse.

Stopping smoking

If you smoke, you should stop. Smoking can speed up the damage caused by chronic pancreatitis, making it more likely your pancreas will stop working sooner.

You can use an anti-smoking treatment such as nicotine replacement therapy (NRT) or bupropion – a medicine used to reduce cravings for cigarettes.

See a GP for help and advice about quitting. They can refer you to an NHS Stop Smoking support service or you can call the NHS Stop Smoking helpline on 0300 123 1044 (England only) for more advice.

Read more about stopping smoking.

Dietary changes

Because chronic pancreatitis can affect your ability to digest certain foods, you may need to change your diet.

A GP may be able to provide you with dietary advice, or you can ask them or your hospital doctor to refer you to a dietitian who will draw up a suitable dietary plan.

A low-fat, high-protein, high-calorie diet with fat-soluble vitamin supplements is usually recommended. But do not make changes to your diet without consulting a health professional.

Enzyme supplements

You may be given pancreatic enzyme supplements to help your digestive system work more effectively.

Side effects of these supplements include diarrhoea, constipation, feeling sick, vomiting and tummy pains. See a GP if you experience side effects, as your dosage may need to be adjusted.

Steroid medicine

Steroid medicine is recommended for people with chronic pancreatitis caused by problems with the immune system because it helps to relieve the inflammation of the pancreas.

However, taking steroid medication for a long time can cause side effects such as osteoporosis and weight gain.

Pain relief

Pain relief is an important part of the treatment of chronic pancreatitis.

Mild painkillers

In most cases, the first painkillers used are paracetamol, or anti-inflammatories such as ibuprofen.

But taking anti-inflammatory painkillers on a long-term basis can increase your risk of developing stomach ulcers, so you may be prescribed a proton pump inhibitor (PPI) to protect against this.

Stronger painkillers

If paracetamol or anti-inflammatories don't control the pain, you may need an opiate-based painkiller, such as codeine or tramadol. Side effects include constipation, nausea, vomiting and drowsiness.

Constipation can be particularly difficult to manage, so you may be prescribed a laxative to help relieve this. See the page on constipation for more information.

If you feel drowsy after taking an opiate-based painkiller, avoid driving and using heavy tools or machines.

Severe pain

If your pain is severe, you may be referred to a specialist (a gastroenterologist or pancreatico-biliary surgeon) or pain centre for further assessment.

You may be offered surgery to help relieve the pain or treat any complications.

In some cases, additional medicine – called amitriptyline, gabapentin or pregabalin – may be recommended to help relieve the pain.

If this isn't effective, severe pain can sometimes be relieved for a few weeks or months using an injection called a nerve block. This blocks the pain signals from the pancreas.

Severe episodes

If the inflammation of your pancreas suddenly gets worse, you may need a short stay in hospital for treatment.

This might involve having fluids delivered directly into a vein and oxygen through tubes into your nose.

Read more about treating acute pancreatitis.

Surgery

Surgery can be used to treat severe pain in people with chronic pancreatitis.

Endoscopic surgery

Patients with gallstones in the opening of their pancreas (the pancreatic duct) may benefit from endoscopic surgery and a treatment called lithotripsy.

Lithotripsy involves using shock waves to break the stones into smaller pieces. An endoscope is then used to access the pancreatic duct so the pieces can be removed.

This treatment may improve pain to some extent, but the benefit may not be permanent.

Pancreas resection

In cases where specific parts of the pancreas are inflamed and causing severe pain, they can be surgically removed. This is called a pancreas resection and may also be offered if endoscopic treatment doesn't work.

The exact technique used for pancreas resection depends on which parts need to be removed.

Speak with your surgical team about the benefits and risks of the procedure before deciding to go ahead with it.

Total pancreatectomy

In the most serious cases of chronic pancreatitis, where the pancreas has been extensively damaged, it may be necessary to remove the entire pancreas (total pancreatectomy).

This can be very effective in treating pain, but you wont be able to produce the insulin that's needed by your body any more. To overcome this problem, a technique called autologous pancreatic islet cell transplantation (APICT) is sometimes used.

During APICT, the islet cells responsible for producing insulin are removed from your pancreas before your pancreas is surgically removed. The islet cells are then mixed with a special solution and injected into your liver.

If APICT is successful, the islet cells remain in your liver and begin to produce insulin.

In the short term, APICT appears to be effective, but you may need additional insulin treatment in the long term.

Other tests and checks

If you've been diagnosed with chronic pancreatitis, you should be offered:

• annual checks (every 6 months in under-16s) to make sure your diet is giving you the nutrients you need
• a bone density assessment every 2 years – problems with digesting foods may affect your bone health
• a blood test for diabetes every 6 months
• an annual check for pancreatic cancer if the cause of chronic pancreatitis is hereditary