Chronic pancreatitis is inflammation of the pancreas that worsens over time. It causes scarring and permanent damage to the pancreas.

The pancreas is a large gland behind the stomach that makes enzymes (digestive juices) that travel to the upper portion of the digestive tract, where they help to digest food.

In a healthy pancreas, these enzymes do not become active until they reach the upper part of the digestive tract. But when the pancreas is inflamed, the enzymes become active while they are still in the pancreas, and begin attacking the tissues inside the pancreas. These tissues become damaged and cannot produce new enzymes. Scar tissue develops over time and the pancreas shrinks in size. When that happens, the pancreas cannot produce enough enzymes needed for digestion.

Over time, this tissue damage can become permanent. The ability to digest food is impaired and the pancreas cannot produce enough enzymes to help control blood sugar. At this point, the pancreatitis is considered chronic.

How Common Is Chronic Pancreatitis?

Chronic pancreatitis is rare in children. It can be diagnosed at any age but is more common after the age of 10. Pediatric specialists at Cincinnati Children’s care for patients with chronic pancreatitis who are as young as 3 years of age.

What Causes Chronic Pancreatitis?

Causes of chronic pancreatitis in children may include:

• Gallstones or a blockage in the pancreatic duct
• A metabolic abnormality, such as high levels of calcium in the blood
• Heredity or genetics (passed on from family)
• Trauma to the pancreas

Other causes include medication, an infection or another disease, such as cystic fibrosis. However, in many cases, the cause of chronic pancreatitis in children is unknown.

Problems Associated with Chronic Pancreatitis

The main problem for those with chronic pancreatitis is chronic pain. Chronic pancreatitis can cause serious complications, including:

• Dehydration or low blood pressure
• Bleeding, tissue damage and infection
• Fluid-filled cavities (pseudocysts)in the pancreas, which can cause vomiting and fever
• Injury to the heart, lungs and kidneys or other organs when digestive enzymes and toxins enter the bloodstream
• Diabetes mellitus due to the loss of pancreatic tissue and cells that produce insulin
• Fat not getting absorbed into the body which leads to fatty stools due to a lack of digestive enzymes
• Diarrhea, bellyaches, bloating and distension (a protruding belly)

Signs and Symptoms

Chronic pancreatitis begins with multiple episodes of acute pancreatitis. These episodes typically involve intense upper abdominal pain, vomiting and nausea.

The most common symptom of chronic pancreatitis is pain in the upper belly that is much worse than a typical bellyache. A child may describe it as severe or have trouble standing or sitting upright. The pain can be constant, come and go, and worsen after eating, especially after eating foods that are high in fat.

Another common symptom is weight loss. This is due in part to not being able to absorb nutrition. In some cases, children avoid eating because it aggravates painful symptoms. Sometimes, pancreatitis can cause a loss of appetite, which leads to weight loss.

Other symptoms of chronic pancreatitis include:

• Nausea
• Vomiting (vomit may be yellowish, greenish or brownish)
• Diarrhea and oily bowel movements
• Trouble digesting food and poor growth
• Diabetes mellitus
• Jaundice (yellow discoloration of the skin)
• In some cases, back pain or left shoulder pain

Diagnosing Chronic Pancreatitis

Because symptoms of chronic pancreatitis resemble those of other illnesses, diagnosing it can be challenging. Pancreatitis is sometimes misdiagnosed as constipation, heartburn, inflammatory bowel disease or irritable bowel syndrome.

To diagnose chronic pancreatitis, a physician will perform a thorough physical exam and ask questions about the child’s medical history. Tests may include:

• Blood tests to see how well the pancreas is functioning and check the pancreas enzyme levels and to check the production of insulin and if the pancreas enzymes are high
• Endoscopic retrograde cholangiopancreatography (ERCP), an imaging procedure used to examine the small intestine, pancreatic duct and other parts of the gastrointestinal tract.
• A CT scan of the belly. This technology uses X-rays and computer technology to reveal signs of damage to the pancreas.
• An MRI (magnetic resonance imaging), which can show abnormalities in the pancreatic duct
• Stool tests
• Genetic tests that can identify a possible hereditary (inherited) cause

Treating Chronic Pancreatitis

There is no cure for chronic pancreatitis, but treatment can ease the symptoms and improve a child’s quality of life. It is important to treat chronic pancreatitis as soon as possible because repeated inflammation can cause permanent damage. Treatment options include:

• Taking pancreatic enzymes to aid in digesting nutrients
• Following a special diet and/or taking vitamins to address the body’s inability to absorb certain nutrients
• Surgically removing the gallbladder or pancreas
• Taking medication to correct a metabolic imbalance
• Undergoing endoscopic retrograde cholangiopancreatography (ERCP) to relieve a blockage that is causing pancreatitis

Total pancreatectomy and islet cell autotransplantation

In rare cases, a child may undergo a surgery called a total pancreatectomy and islet autotransplantation (TPIAT). This involves removing the entire pancreas and reconstructing the gastrointestinal tract. After the pancreas is removed, it is taken to an islet laboratory where the islet cells are extracted. These cells are responsible for producing insulin and other hormones. The islets are then transplanted into the patient’s body, where they continue to perform essential functions of the pancreas.

Although TPIAT is a complex surgery, the operation can be life-changing for patients in whom previous interventions have not resulted in relief from the painful symptoms of pancreatitis.

Pain Management

Chronic pancreatitis can cause intense upper belly pain. Minimizing this pain and helping your child cope with it is a high priority. A pediatric pain specialist can offer medication and strategies to help your child cope with painful symptoms while also minimizing the use of narcotics. A pain psychologist can also help by providing coping strategies to deal with the pain.

Learn more about Cincinnati Children’s Pain Management team.

Outlook for People with Chronic Pancreatitis

Not all children who experience acute episodes of pancreatitis will develop chronic pancreatitis, but some will.

Unfortunately, chronic pancreatitis is a lifelong condition, although symptoms sometimes come and go. Patients should see their doctor on a regular basis to evaluate their condition, ensure that they are getting enough nutrition and discuss treatment options. The doctor will provide endocrine testing on a regular basis to identify any issues related to glucose tolerance or the development of diabetes.

Children with chronic pancreatitis may be at an increased risk of developing pancreatic cancer. The degree of risk depends on the underlying cause of pancreatitis, family history and the type of the genetic involvement.