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Pancreatitis is an inflammation of the pancreas that causes digestive enzymes to attack and damage surrounding tissues. It can be acute (striking suddenly) or chronic (ongoing). With chronic pancreatitis, the inflammation does not heal but worsens over time. This can lead to permanent tissue damage, diabetes, and severe pain.
The symptoms of pancreatitis typically include upper abdominal pain, which can get worse after eating. There can be nausea as well. The pain may occur a few times a week, or constantly, and be quite debilitating.
For some, inflammation and scarring of the pancreas leads to pancreatic insufficiency. This condition presents as oily diarrhea from abnormal digestion. These patients need to take pancreatic enzyme capsules to replace the enzymes they are missing. A small percentage of these patients may develop diabetes.
We know that heavy alcohol use is associated with chronic pancreatitis. But we have learned that alcohol is only a factor in a small minority of people. Many people, from youngsters to adults, have unexplained chronic inflammation of the pancreas.
Patients say pancreatic pain can be unbearable. Every meal can make the pain worse, because eating triggers digestion, which turns on the pancreas. Some patients compare pancreatitis pain to lit cigarettes smoldering in the upper abdomen.
Chronic pancreatitis can be difficult to diagnose because CT and MRI scans, as well as standard blood tests, can show up as normal. In these patients, we perform a secretin pancreatic function test to analyze how the pancreas is functioning. The Pancreas Center at Beth Israel Deaconess Medical Center is one of the few centers in the world that performs an endoscopic secretin pancreatic function test, a highly sensitive test that can diagnose pancreatitis up to three years before there are changes visible on an MRI or CT scan.
We base the diagnosis of pancreatitis on symptoms that are typical for chronic pancreatitis, along with either an abnormal CT or MRI scan, an abnormal endoscopic ultrasound, or abnormal secretin pancreatic function test.
Cystic fibrosis is an inherited disease that can affect the pancreas and other organs that secrete fluids and make mucus. Our research has discovered that approximately 50 percent of patients with chronic pancreatitis also have a mutation in the gene that causes cystic fibrosis.
This breakthrough is significant for two reasons. First, it gives patients a cause for pancreatitis, which is important because many associate this disease with alcohol abuse. Second, the discovery opens up the potential for new therapies aimed at correcting defects in the cystic fibrosis gene.
We are working on three clinical trials for patients with chronic pancreatitis. The first is combining a simpler form of transcranial magnetic stimulation, called tDCS, with meditation, to decrease pain. The second trial focuses on using high doses of omega-3 fish oil to correct abnormalities related to the cystic fibrosis gene. The goal is to see whether this treatment is effective for chronic pancreatitis. The third study analyzes whether markers in blood samples can improve our ability to diagnose chronic pancreatitis, and predict an increased risk for pancreatic cancer.
We are studying transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in clinical trials. These therapies target and calm the brain networks that register pain. Our studies found that applying a very focused beam of magnetic stimulation to a specific region of the brain could improve pain in about 70 percent of patients with chronic pancreatitis from no known cause. This non-surgical, easy to tolerate treatment is bringing people great relief without narcotics.
Even if you remove the pancreas, you have a 50 percent chance that you will have your exact same pain from chronic pancreatitis. Your brain still gets the sensation that your pancreas hurts. That is why we are studying treatments like TMS and tDCS, which block the neuronal pathways where the pain originates.
Treatments for pancreatitis can include conventional medication and surgery, and new therapies such as clinical trials. Managing pain is a key goal. Prescribing narcotics (heavy-duty pain pills) is not always the best answer. We look for alternatives such as TMS or tDCS to calm the brain networks that register pain, mind/body solutions such as meditation, and nerve blocks and other medicines.
In our research and treatment advances, we strive every day to cure pancreatitis. For some people, the pain disappears as mysteriously as it started. But for most, there are no cures. Still, we have many promising avenues in clinical trials. Dr. Steven Freedman’s group has taken the lead nationally by identifying that mutations in the gene that causes cystic fibrosis can lead to pancreatitis in many people. This discovery opens the door to new therapies to correct these defects, and cure this debilitating disease.
Call the Pancreas Center at BIDMC for a second opinion. We are specialists at diagnostic dilemmas. We can provide a definitive diagnosis and a thoughtful plan to help restore your quality of life. Dr. Steven Freedman, Director of our Center, is widely regarded as an authority on pancreatic disorders. He is considered one of the world’s leading researchers in the causes and cures of pancreatitis. Call 617-667-5576 to make an appointment; we promise to see you within a week.
If a parent or sibling has pancreatic cancer, then your risk for this same disease may be higher. We spend a lot of time talking to patients about what we know, and don’t know, about pancreatic cancer. If you do not have symptoms, how often should you be screened, and what type of screening should be done? If you do have a personal history of pancreatic cancer, what type of surveillance measures should you take, and how often? At the Pancreas Center at BIDMC, we can advise you with answers to these questions, create a plan for you, and alert you when new research comes to light that can change your strategy and thinking.