Chronic pancreatitis is the presence of inflammation in the pancreas that worsens over time, gradually causing permanent damage to the organ. It leads to an impairment in the exocrine as well as the endocrine functions of the pancreas.
The symptoms of chronic pancreatitis exhibit episodes of severity occurring in intermissions, along with continuous pain. One of the major symptoms of this disease is epigastric abdominal pain that radiates to the back, probably due to the obstruction of the pancreatic duct. The severity of the pain may vary: sometimes it may require opiate analgesics whereas at other times, it may not be a problem. Other symptoms of the condition include nausea, vomiting, reduced appetite, exocrine and endocrine dysfunction. Exocrine dysfunction leads to weight loss, protein deficiency, diarrhea and steatorrhoea. Endocrine dysfunction leads to the development of secondary diabetes mellitus.
The diagnosis of chronic pancreatitis is not easy because the imaging scans and blood tests for this disease are not very specific. Blood tests are used to evaluate the levels of the pancreatic enzymes, the blood sugar and the functioning of the liver and the kidneys. Stool may also be tested for the presence of enzymes and fat. Pancreatic images are checked using computerized tomography, X-rays, magnetic resonance cholangiopancreatography and transabdominalultrasound  .
The treatment of chronic pancreatitis has to be started as soon as it is diagnosed. Delay in treatment may cause irreversible damage to the pancreas and lead to chronic pain that is difficult to treat. Most patients experience pain relief by the use of non-opioids like ibuprofen and acetaminophen along with antioxidants. An injection can block the celiac plexus preventing the nerves of the pancreas from reporting pain to the brain.
Surgical options are considered if medical options fail. Lateral pancreaticojejunostomy provides pain relief to nearly 80 percent of the patients. Pancreatic inflammation can also be removed by Whipple's procedure. Total pancreatectomy with islet auto-transplantation provides symptom relief. Antioxidant regimens consisting of a mixture of vitamin C and E, methionine and selenium are used reasonably in the management of oxidative stress in chronic pancreatitis .
The prognostic factors related to chronic pancreatitis are the diagnostic age, alcohol consumption, smoking and liver cirrhosis. The survival rate of the people with chronic pancreatitis in a study conducted at an international level was found to be 70% after 10 years of the disease, and 45% after the passage of 20 years. The risk of the development of pancreatic cancer was 4% after 20 years.
Common complications of the disease are the mechanical obstruction of the bile duct and the duodenum, and pseudocyst formation. A pseudocyst collects the pancreatic juice and encloses it within a granular or fibrous tissue. Pseudocysts develop in around 10% of the patients with chronic pancreatitis. Diabetes mellitus and pseudoaneurysm are the other complications of this disease .
The main cause of chronic pancreatitis is metabolic. Some of the pathological reasons for this disease are intra-ductal obstruction by tumors or stones, toxic metabolites that release cytokines (from the pancreatic acinar cells), necrosis, fibrosis, oxidative stress, ischemia, alcohol consumption and autoimmune disorders. Obstruction of the flow of the pancreatic juice can be congenital or acquired.
Hereditary pancreatitis is an autosomal dominant disorder accounting for 1% of the cases. Cystic fibrosis, an autosomal recessive disorder, accounts for a small number of the cases of chronic pancreatitis. Autoimmune pancreatitis shows the clinical features of an enlarged pancreas, narrowed pancreatic duct, gamma globulin circulation and auto-antibody presence. Causes of the disease in nearly 30% of the cases are idiopathic. Some of the rare congenital causes include pancreas divisum and annular pancreas divisum. Blunt abdominal trauma, resulting from accidents, leads to acquired obstructive chronic pancreatitis. Other causes are hyperlipidemia, hypercalcemia, nutritional pancreatitis and medications  .
It is estimated that in industrialized countries, only 3.5 to 10 among 100,000 people develop chronic pancreatitis. This disease mostly develops in the patients aged 30 to 40 years, more commonly in men than in women. It is estimated that every year approximately 87,000 cases of pancreatitis are reported in the hospitals of the United States. Alcohol stimulated disease is mostly seen in males, while idiopathic and hyperlipidemic induction of this disease is usually seen in females .
Pancreatic fibrogenesis is a typical response to the injury. The deposition of the extracellular matrix and fibroblast proliferation in the pancreas involves a complex interplay of cytokines, growth factors and chemokines. When there is an injury in the pancreas, the release of the transforming growth factor beta and its local expression stimulates mesenchymal cell growth and increases the synthesis of extracellular matrix proteins like fibronectin, proteoglycans and collagens. There is evidence that chemokines are involved in the beginning and progress of chronic pancreatitis .
An inflammation in the pancreas that lasts for a short period is called acute pancreatitis and that which lasts for a longer period is termed chronic pancreatitis. With time, pancreatitis results in damage and scarring of the pancreas. Calcium stones that develop in the pancreas can block the outlet or the pancreatic duct which transfers the pancreatic enzymes and pancreatic juices to the gut. A reduction in the levels of pancreatic enzymes causes maldigestion, whereas a reduction in the pancreatic hormones impairs blood sugar regulation. Low levels of pancreatic enzymes lead to malnutrition due to poor absorption and the loss of a higher amount of fat in the stools. If the blood sugar level is not maintained within the normal limits, diabetes may result .
Pancreatic inflammation that has reached a stage of permanent damage to the tissue is termed as chronic pancreatitis. This disease leads to digestive disability and impaired synthesis of pancreatic enzymes.
Obstruction of the pancreatic duct, alcohol abuse and autoimmune disorders are some of the common causes of chronic pancreatitis. Abdominal pain, nausea, vomiting, decreased appetite, exocrine and endocrine dysfunction are some of the symptoms of chronic pancreatitis.