Q: I am a 30 years old woman who has been admitted in hospital twice due to severe attacks of pancreatitis in the last 2 years. At the time of the first attack it was found from the CT scan, it was observed that I had oedema on the periphery of the pancreas. Then an endoscopic retrograde cholangiopancreatography (ERCP) was done. My gallbladder was also operated upon 2 years back at the time of the first attack. The next year I was admitted with the same problem and I got well in 5 days only. The doctor prescribed pancreatic enzymes (Creon 25000 thrice a day), antacid and antioxidants. Now I am suffering from abdomen pain, loose motions, irregular bowel movements all the time, nausea and loss of appetite for the last 2 months, though I take only fat and protein free boiled or liquid diet. At present my serum lipase and amylase is within the normal range. The routine stool examination showed no enteric disease or fat mal-absorption. Serum calcium and blood glucose level was also normal. My recent ultrasound indicates chronic pancreatitis with dilated duct. No calculi or cyst is observed. Please advise.

A:I would recommend that a stool sample be tested for Faecal pancreatic elastase, and if it is low, the Creon should be increased to 50,000 units thrice daily. An endoscopic ultrasound should also be carried out to find out whether the pancreatic ductal dilatation is due to a stone impacted in the ampulla or in the pancreatic duct in the head of the pancreas. Pain control should be improved with round the clock paracetamol, and as needed codeine phosphate. Please also check serum triglycerides as a potential cause of pancreatitis since you have not mentioned that the patient consumes excess alcohol or that there were gall stones found at ERCP.