What is chronic pancreatitis? Symptoms, treatment

In the structure of diseases of the digestive system the proportion of component from 5.1 to 9 %, belongs to chronic pancreatitis (CP). In these ailments affects the pancreas, inflammation begins. As a result, the body degenerative changes occur. First, the pathological process can occur in the tail of the pancreas, its head or the middle part. The outcome is the defeat of the entire body. Some people with chronic pancreatitis, in the end die. Mortality the world average is about 11 %.

Read More about the disease

So, what is chronic pancreatitis? This term experts refer to a whole group of diseases of the pancreas. For all diseases have the following characteristics:

• Phase-progressive course with episodes of acute pancreatitis;
• Focal, segmental or diffuse damage to the pancreas parenchyma with subsequent replacement by connective tissue;
• Changes in the ductal system of the body;
• Formation of cysts, pseudocysts, stones and calcification;
• Development of the endocrine and exocrine insufficiency.

The fact that there are different types of diseases, the international statistical classification of tenth revision. Chronic pancreatitis ICD-10 is divided into:

• CP of alcoholic etiology (code К86.0);
• Other HP — infectious, repetitive, recurrent, unspecified etiologies (code К86.1).

The Most frequent reasons of development of chronic pancreatitis

The disease most Often occurs because of alcohol abuse for extended periods of time. In men chronic pancreatitis the pancreas may develop if they drink more than 15 years. In women, the likelihood of illness increases with abuse of alcohol for more than 10 years.

Alcohol — not the only factor contributing to chronic pancreatitis. The cause of the disease may be to Smoking. Substances that enter the lungs with the smoke enter the bloodstream and spread throughout the body, have a negative impact on all internal organs, including the pancreas.

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Other causes of disease

Other factors that cause chronic pancreatitis (code according to ICD-10 — and 86.0 86.1), include:

• The abuse of fatty foods, long-term protein-free diet;
• Various diseases of the gastrointestinal tract (neoplasm, cholecystitis, etc.);
• Overweight, obesity;
• Taking certain drugs (“Azathioprine”, “Furosemide" "Prednisolone" of the synthetic estrogen, “?”, “Ampicillin” etc.);
• Infection by viruses (cytomegalovirus, hepatitis virus B, C, etc.).

Studies conducted in recent years showed that there is a hereditary chronic pancreatitis pancreatic. This is an autosomal dominant disease with incomplete penetrance (with different frequency of gene in the phenotype of carriers). Patients have hereditary chronic pancreatitis manifests itself quite early. However, the final stage comes later than with other forms of the disease.

Forms of pancreatitis

There are different classifications of the disease. One of them is a list of the following forms of chronic pancreatitis.

1. Recurrent. It occurs in 55-60 % of cases. In this form of periods of remission replaced exacerbations of the pathological process.
2. Constant pain. This form is found much less frequently (in 20% of cases). When her patients complain of persistent pain localized in the upper abdomen and radiating to the back.
3. Pseudopoecilia (jaundice). The incidence of this form of chronic pancreatitis is 10 %. For a pathological process characterized by the development of inflammation in the head of the pancreas and compression of the common bile duct.
4. Silent (latent). Form is detected in 5-6 % of cases. Pain when disease is mild or not felt at all. Periodically having dyspepsia due to dysfunction of the pancreas.
5. Sclerosing. In this form of pain occurs in the upper abdomen. They are worse after meals. The pain is accompanied by nausea, loose stools, weight loss. When conducting ultrasound specialists notice a decrease in size and compaction of the pancreas.

According to the Marseille-Rome classification, there are such forms of pancreatitis, as calcified, obstructive and parenchymal fibrosis. The first of them has been uneven lobular lesions of the pancreas. In the ducts appear to be a pseudocyst, cyst, calcification, stones. What is chronic obstructive pancreatitis in the form? During this type of disease internal organ is affected evenly. The stones are not formed, there is obstruction of the main pancreatic duct. With parenchymal form in the parenchyma of the developing inflammation. Calcification does not form ductal system is not affected. For fibrosischaracterized by the replacement of parenchymal internal organ connective tissue. This process progresses, Exo - and endocrine insufficiency.

Symptoms

Speaking about what is chronic pancreatitis, it is necessary to consider the signs of this disease. In the early stages during periods of exacerbations observed attacks. For them, characterized by pain in the epigastrium. In most cases they are radiating posteriorly. Much less frequently observed girdle pain. People suffering from chronic pancreatitis attacks occur because of the effects on the body precipitating factors. Them is the intake of fatty foods, alcohol and carbonated drinks.

The disease is also characterized by dyspepsia syndrome. Approximately 56% of sick people point nausea and vomiting. 33 % of the observed weight loss in 29 % — flatulence, 27 % — loss of appetite. When the disease may appear symptoms such as weakness, fatigue, reduced working capacity.

Chronic pancreatitis

Experts distinguish 4 stages in the development of the disease:

1. Preclinical stage. At this stage, sick people do not notice the symptoms of chronic pancreatitis. The disease is often detected incidentally when performing ultrasound or computed tomography of the abdominal cavity.
2. The stage of initial manifestations in the development of such a disease as chronic pancreatitis. Adults at this time begin to torment the first symptoms of the disease. The duration of the stage can be several years. In some cases, the disease progresses very quickly.
3. The stage of development of permanent clinical symptoms. Patients show signs of endocrine and exocrine insufficiency. People eat very little, complain of abdominal pain.
4. The Final stage. Pain become less pronounced. People significantly lose weight. At the final stage, there are various complications of chronic pancreatitis due to atrophy of the pancreas, endocrine and exocrine insufficiency. One of them is named cancer of internal organ.

Depending on the characteristics of the development of chronic pancreatitis isolated for easy, average degree and severe course of the disease. In less severe periods of relapse occur rarely (1-2 times per year). Pain are moderate. The functions of the pancreas are not violated.

What is chronic pancreatitis of moderate severity? This is a disease in which there is 3-4 exacerbations per year. They are longer than in mild pancreatitis. Patients have reduced body mass. Moderately reduced exocrine function of the pancreas, pancreatic hyperfermentemia observed.

In severe disease exacerbation frequent and prolonged. Pain accompanied by severe diarrhoeal syndrome.

Treatment of disease: goals and necessary steps

In chronic pancreatitis therapy is indicated to achieve the following purposes:

• Reduction of the clinical manifestations of the disease;
• Prevention of recurrence;
• Reducing the likelihood of complications.

Specialists prescribe their patients non-pharmacological treatment, drug therapy. When necessary, performs surgery. Treatment of chronic pancreatitis in adults can be performed at home and in the hospital. The indication for hospitalization is the transition of the disease in the acute stage, because in this period there is a threat of life of the patient and the need for parenteral administration of drugs.

Non-drug treatment

In the treatment of chronic pancreatitis plays an important role nutrition. Severe exacerbations are shown hungry days (1-3 or more) and a rich alkaline water. According to the testimony appointed by the parenteral or enteral (administration of nutrients into the colon using a special probe) power. Thanks to this measure fails to stop the secretion of the pancreas, reduced toxicity and becomes weaker pain.

After normalization of sick people are transferred to oral feeding. Meals should be frequent, fractional. The daily menu is prepared from the mucous soups, mashed vegetables, pureed liquid milk porridge. From drinks allowed compotes, jellies, weak tea, mineral water, broth hips.

Be Sure to exclude the following products:

• Provoking flatulence;
• Incorporating coarse tissue;
• Stimulates the production of digestive juices;
• Rich in extractive substances.

Is it Possible in chronic pancreatitis there is meat and fish broth, mushroom and strong vegetable broths, canned food, smoked food, sausages, fatty fish and meat, fried dishes, vegetables and fruits raw, muffins, confectionery, brown bread? All of these products is prohibited during exacerbation of the disease, and therefore should be refused. You also need to remove from your menu spices, ice cream, alcohol.

During remission diet changes a little. People with a diagnosis of "chronic pancreatitis of the pancreas" are allowed to eat pasta, raw vegetables and fruits, soft mild cheese, baked fish. Pureedsoups you can substitute regular veggie (cabbage ingredients you want to exclude). Porridge can be crumbly, more dense.

Pharmacotherapy of chronic pancreatitis

The Goal of drug therapy at the first stage is to provide a functional rest the pancreas. This is achieved through:

1. Receiving large doses of modern multienzyme funds. Such drugs include “Mezim-Forte», “CREON», ‘Were».
2. Maximum inhibition of acidic gastric secretion by using blockers of H2-receptors of histamine (“Ranitidine», “Famotidine»), or proton pump inhibitors (“Omeprazole», “Esomeprazole»). The drug is administered parenterally or taken in.
3. The introduction of “Octreotide» or “the Sandostatin». These drugs are synthetic analogs of the hormone somatostatin. Thanks to them, reduced hypertension in the ductal system of the pancreas, and due to this weakened and relieved the pain.

If therapeutic measures are aimed at reducing pancreatic secretion, do not have analgesic action, doctors prescribe non-narcotic or narcotic analgesics. “Pain”, “Ketoprofen”, “Paracetamol” — any remedy for chronic pancreatitis can be prescribed by a doctor from the first group of drugs. Of drugs related to narcotic analgesics, can be selected "Morphine”, “Tramal”, “Fortran”.

Treatment of chronic pancreatitis in adults can also involve substitution multienzyme therapy. Indications for its purpose — the allocation of faeces more than 15 grams of fat per day, diarrhea, rapid weight loss. Multienzyme preparations are “Abomin», «Forte-N”, “CREON”, “Pancreatin”, “Festal”, “Pancreatic”, “Digital”, “backed”.

Surgical treatment

In some cases in chronic pancreatitis surgical intervention is required. Indications are:

• Pain that are not stopped with the help of medicines and diet;
• The presence of abscesses and cysts in the pancreas;
• Obstruction of the bile ducts, which cannot be resolved with the endoscopic method;
• Stenosis of the duodenum;
• Fistula in the pancreas with the development of pleural effusion or ascites;
• Suspected cancer, not confirmed cytologically or histologically.

"Chronic pancreatitis, the symptoms and treatment in adults" — an important medical issue that needs attention. It is an insidious disease, a progressive and irreversible process. However treatment is still necessary. It allows to prolong life of sick people, eliminates the unpleasant symptoms characteristic of chronic pancreatitis. For example, when following the recommendations for diet, abstinence from alcohol, proper drug therapy, patients live up to 10 years. Half of those persons who do not seek treatment and continue to drink alcohol, Smoking, wrong eating, and die earlier.