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Liver and Pancreas Internal Medicine disease: Chronic Inflammation of the Pancreas

Fibrosis of pancreas advances.

This disease is that persistent inflammation is developed in pancreas by various causes (long-term and polyposis alcoholic drinking), then pancreas cell is broken and fibrosis is increased. It is assumed that approximately 67,000 patients exist in Japan. This is roughly 50 patients per 100,000 people. In the chronic inflammation of the pancreas, abdominal pains may come up, or may lead to disorder of nutrition or diabetes. Also, it is reported that it becomes a risk factor for pancreas cancer.

When chronic inflammation of pancreas advances, it is set as irreversible so that it becomes important not to advance further at the time of diagnosed.

70% of the cause is long-term and polyposis of alcoholic drinking

The most common cause is long-term and polyposis alcoholic drinking. It takes about 70 % overall. Other than this, change after acute pancreas inflammation, gallstone or autoimmunity can be listed, but they say that there is about 20% of unknown cause cases.

Abdominal pain is weakened along with pancreatic function lowering.

Typical symptom is an abdominal pain. Other than this, pancreas has the function of external secretion (produces digestive pancreatic fluid) related to digestive absorption, and internal secretion producing several hormones (typical hormone is blood glucose decreasing insulin). So that disorder of external secretion lead to nutritional disorder, disorder of internal secretion, especially decrease of insulin, lead to diabetes.

Chronic inflammation of Pancreas is classified with below listed 3 groups, and their symptom varies depend on the time period of the disease.

Primary observations at image inspection are Pancreas atrophy and calcification.

As diagnosis reference, judging from the observation of symptom, blood test and imaging test, is available so that diagnosed with using this reference. In the blood test, amylase will increase reflecting pancreas cell destruction. Also, in reflecting undernutrition, there is a case where albumin, hemoglobin, and cholesterol are showing lower value.

In abdominal imaging test, typical one is ultrasound or CT, typical observations are Pancreas atrophy and calcification in pancreas. Also, at MRI, especially it can focus on pancreatic duct, but it is characterized in uneven stenosis of the pancreatic duct and extension. These are relatively less burden testing but in case they are unable to diagnose, special endoscopic examination, such as EUS (ultrasonic endoscope) or ERCP (Endoscopic pancreatic duct contrast test and Tissue examination), are used to diagnosis.

Basics are limitation of alcohol and/or fat-rich meal.

Internal medicine treatment (lifestyle habit and administration of a drug) is a basic treatment, but for the case which the cause is epidemic, like alcohol or fat-rich meal, making these restricted is the first thing.

For the drug treatment, analgesic medication for abdominal pain, supplemental treatment of digestive enzyme, and proteolytic enzyme inhibitors are administrated. Also, the report says that the symptom has improved by the administration of dietary supplements with limited fat.

By the way, there is a case where concretion developed in pancreas duct causes the symptom like abdominal pain, but in that case, treatment for the concretion becomes necessary. As a less invasive treatment, there is a method where concretion is removed with using endoscope from mouth, but for larger concretion case, firstly fracture concretion with laser or water pressure, or by extracorporeal shock wave device (ESWL) is used, then remove the concretion. In case when removal of concretion is difficult or there exist narrow part in pancreas duct, there is a method that insert a tube (stent) in the pancreas duct to make flow better, then to ease the symptom.

When endoscopic treatment has no effect or recurrence is repeated case, surgical operation (pancreatic ductal decompression or pancreatic resection) is considered to conduct.

Over 10 years shorter than average life expectancy and highly risked group for pancreas cancer.

In regard to the prognosis, averaged life expectancy of chronic inflammation of the pancreas is 67 years old according to the Japanese National Survey. This is over 10 years shorter than normal averaged life expectancy. Most of the cases of the development of chronic inflammation of the pancreas are caused by lifestyle habit, so that it becomes important to review daily lifestyle habit, like to restrict alcohol drinking or fat-rich meal taking. Once the disease is developed, permanent cure is difficult so that improvement of the lifestyle, with aiming to prevent further advancement of the disease, becomes important. And, chronic inflammation of pancreas is well known as highly risked group for pancreas cancer, so that it is recommended to have imaging test once a year.

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