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Chronic Pancreatitis

An irreversible disease that causes unrelenting chronic pain.

Parenchymal Destruction, Chronic Pancreatitis and Traditional Treatments, Department of Surgery, SUNY Downstate Medical Center Pain in Chronic Pancreatitis, Chronic Pancreatitis, Traditional Treatments - Department of Surgery at SUNY Downstate Medical Center

Chronic Pancreatitis is a progressive and irreversible disease resulting in fibrosis ("scarring") and atrophy ("burn-out") of the pancreas.

The destruction of pancreatic tissue initially leads to malabsorption and impaired digestion of food, requiring enzyme substitution with meals ("exocrine dysfunction"). This may lead to the inability to eat and drink, requiring tube feedings via a catheter (placed through nose or stomach into the small bowel) or even complete nourishment via the patient"s blood veins (also called "total parenteral nutrition"). Frequently associated with exocrine dysfunction are bowel movements high in fat quantities with the production of grey, foul smelling stool that float in toilet water.

In its later stages chronic pancreatitis causes the development of diabetes mellitus ("endocrine dysfunction") which may be very brittle in nature and associated with secondary complications of diabetes to the eyes, nerves, blood vessels and kidneys. Patients originally diagnosed with chronic pancreatitis then depend on life-long insulin administration, requiring up to 8 needle sticks a day for blood sugar monitoring and insulin administration.

Associated with chronic pancreatitis is chronic pain. The "chronic pain syndrome" is the result of relentless and intractable pain, so severe in nature that affected patients become completely dysfunctional, unable to work or to perform daily tasks on a regular basis. The most common symptom is unabating and constant upper abdominal pain which typically radiates into the back. Most patients associate this pain as being "stabbed in the back by a knife". As a result of the chronic pain syndrome, patients with chronic pancreatitis frequently become dependent on high doses of opioids and narcotics. Because of their reliance on strong and frequent pain medications, patients with chronic pancreatitis and chronic pain syndrome are frequently labeled as "drug addicts", not only in the emergency room but also by their physicians and sometimes by family members as well.

Chronic pancreatitis and chronic pain syndrome frequently take a tremendous social toll on the patient by losing employment and family ties

Traditional Treatment Options


Basically all medical and most surgical treatment options do not work as long as the diseased pancreas or parts thereof remain in the body. Most of our patients underwent medical options first including (multiple) stent procedures ("endoscopy, ERCP") or nerve ("plexus") blockades and have been prescribed strong pain medications for long periods of time.

Traditional surgical options include removal of the head (“Whipple” procedure) or tail of the pancreas.  However, these operations do not completely remove all pancreatic tissue so pain eventually returns.    Likewise, drainage procedures (“Puestow” procedure) or combined resections plus and drainage (“Frey” or “Beger” procedures) leave diseased pancreas behind. Since drainage procedures also leave diseased pancreatic tissue behind, the pain will eventually come back.

The only treatment option to reliably cure or ameliorate the chronic pain syndrome is the complete removal of the pancreas ("total pancreatectomy") with an islet auto-transplant (TPIAT) to avoid the development of diabetes mellitus in non-diabetic patients with chronic pancreatitis.

The removal of the entire pancreas appears to be a "radical" therapy for a "benign" (i.e., non-cancerous) disease. But patients with chronic pancreatitis know that their disease is not benign. The sooner after the diagnosis of chronic pancreatitis has been established TPIAT is performed, the better is the outcome.