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What is the treatment for chronic pancreatitis?

Q: I am 28 years old and am suffering from chronic pancreatitis. I used to have upper abdomen pain with vomiting since childhood but the problem has become serious over the last few months requiring admission to 4 hospitals. I have lost 10 kilos of weight. A CT scan and MRI indicated that I have calcification in the parenchyma region of pancreas. According the doctors the stones are not big enough for an operation or ERCP for ductal clearance. Only one doctor told me that he will do an ERCP for clearing the duct and treatment will be long, last for 2 years and I will have to come back to him every 6 months. I am following a very low fat diet and regularly taking the medicine prescribed by doctors (enzyme supplement and pantocid) but nothing seems to help the problem. I have a lot of discomfort in the upper abdomen. There is a persistent feeling of lumpiness. My career is at stake. What is the cure for this problem? How can the conditon be handled? If the stones are small then why has the problem increased? Can alternative medicine help me? All other tests are normal. I do not have diabetes. My lipid profile is okay. Only the amylase and lipase were beyond the upper limit of normal.

A:You have chronic pancreatitis with pain as the predominant symptom. This can be treated in a number of ways. One method is the use of pancreatic enzyme supplements and antacids. The second form of treatment is by endoscopy where stones in the duct can be fragmented or occasionally a stent can be placed within the pancreatic duct. The data for stenting is not very exact with some experts claiming it is quite good while others say that in the long term, it is actually damaging. Finally it can be treated with surgery. During surgery if the duct is dilated, one can do a simple operation called pancreatico-jejunostomy. In your case the duct is not dilated and therefore you will need to have a different kind of operation which is more complex and possibly carry a small operative risk. The head of the pancreas, if bulky, can be cored out and occasionally we remove the head. The head of the pancreas is like a pacemaker and unless one deals with it the process of pain relief is not successful. If the symptoms are not progressive, then after many years it is known that pancreatic pain and inflammation can subside on its own. However one must guard against excessive use of pain killers because one can get habituated to it and often it is very difficult to know whether there is actual pain or just a craving for the medicine. Coeliac plexus block, which is an injection given from the back can damage the ceoliac ganglion which will stop the perception of pain in a small number of patients. Perhaps you should see a person who is an expert in pancreatic surgery so that after studying the CT scan and the MRCP film and quantifying how much symptoms you have or more importantly gauze how poor is your quality of life and then decide which form of treatment is the best for you.


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