Chronic pancreatitis

Chronic pancreatitis is a long-term and irreparable inflammation of the pancreas frequently manifesting as severe abdominal pain, nausea and vomiting. ^[1]  

Epidemiology

The prevalence globally is about 4-5%. Median age of affected individuals is 51 years old. The condition affects more males. ^[1] Recorded cases of hospitalization are higher among blacks. 87,000 cases are documented every year in the U.S. ^[2]

Causes

There are a lot of theories suggested in the pathophysiology of the disease. One of these is blockage of bicarbonate excretion or when the excretion is significantly decreased. ^[1] Majority of cases are linked to too much consumption of alcohol. Smoking also enhances the risk of developing chronic pancreatitis. ^[3] Autoimmune process is another suggested pathophysiology wherein the affected person makes antibodies against his own pancreatic cells. Some individuals have genetic makeup that makes them more prone to have the condition. Other causes include inborn pancreatic abnormalities, hyperlipidemia, hypercalcemia, medications and nutritional problems. ^[2]

Signs and Symptoms

Abdominal pain is the most common symptom. Usually it is described as intermittent, severe and is localized either in the middle area or in the left upper part of the abdomen. The pain may radiate to the back and may be felt after meals. Patients often lie on the left side while drawing the knees toward the chest in an attempt to relieve the pain. Usually the pain does not follow any pattern thus delay in diagnosis is common. Other people experience diarrhea and weight loss. Some may notice their stool to be loose and with pale color. Nausea and vomiting are also common. ^{[1] [2]}

Diagnosis

After history taking and physical examination, laboratory exams are often done. These include blood tests to determine serum amylase and lipase levels. Serum calcium and triglyceride levels are also obtained to search for possible causative factors. Since malabsorption can also become part of the clinical picture, fecal tests can be requested as well. Pancreatic tests which can be direct and indirect are available. Direct ones are the most sensitive however they can be too expensive and invasive. Imaging tests like abdominal radiography and CT scan are also helpful. ^[2]

Treatment

Pain and malabsorption have to be given proper medical attention. Patients are instructed to take nothing by mouth and are given fluids through vein. Surgical therapy may be indicated on some circumstances such as when there is a presence of abscess, fistula or obstruction. Some patients may need endoscopic treatment. In all cases, behavior modification is important. Patients are advised alcohol and smoking cessation. ^[2]

References:

1.      http://www.patient.co.uk/doctor/chronic-pancreatitis

2.      http://emedicine.medscape.com/article/181554-overview#a0156

3.      http://www.nhs.uk/Conditions/Pancreatitis-chronic/Pages/Introduction.aspx

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Selenium Supplement [1, 5, 6, 7, 8, 9, 10, 11, 12, 13]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. IMPORTANT: Selenium is toxic in high doses. Massive overdoses can cause kidney failure, breathing difficulty and death. Selenium should only be taken at healthy levels which the body is able to tolerate.

Recommendation:  No recommendation (Available evidene does not support claims that selenium helps to prevent or treat pancreatitis)

Grade of Evidence: Very low quality of evidence

Chlorella (Green Algae, Chlorella Pyrenoidosa) [1, 2, 3, 4]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (There is insufficient evidence to support claims that Chlorella helps to treat pancreatitis in any way)

Grade of Evidence: Very low quality of evidence

Medium Chain Triglycerides (MCT Oil) [14, 15, 16, 17, 18]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (Studies show that MCT oil may be beneficial to those that have chronic pancreatitis)

Grade of Evidence: Low quality of evidence

* www.gradeworkinggroup.org