Chronic pancreatitis
Long-standing pancreatic inflammation leading to scarring, exocrine insufficiency (poor fat digestion), endocrine failure (diabetes) and persistent abdominal pain. Common after years of heavy alcohol use; also genetic, autoimmune, gallstone-related, or idiopathic.
What it is
Chronic pancreatitis is the irreversible end-stage of repeated or prolonged inflammation of the pancreas. Fibrosis and calcifications replace functioning glandular tissue, eventually crippling both the exocrine pancreas (digestive enzymes for fats, proteins, carbohydrates) and the endocrine pancreas (insulin-producing islet cells). The classic patient is in their 40s–60s, with a 5–20 year history of heavy alcohol, presenting with weight loss, fatty foul-smelling stools (steatorrhoea), and dull mid-epigastric pain radiating to the back. Modern series increasingly identify non-alcoholic causes — hereditary (PRSS1, SPINK1 mutations), autoimmune (IgG4-related), tropical, post-recurrent acute pancreatitis (commonly gallstone-induced), and smoking-related.
Key lab markers
- Lipase, amylase — often normal in established disease (the gland has already burnt out); diagnostic in acute flares only.
- Fasting glucose, HbA1c — pancreatic diabetes (type 3c) presents in 40-70% with advanced disease.
- Fat-soluble vitamins (D, A, E, K), B12 — deficiencies from malabsorption; check at diagnosis and yearly.
- Faecal elastase-1 — gold standard for exocrine insufficiency (<200 µg/g abnormal, <100 severe).
- CT or MRCP imaging — calcifications, ductal dilation, atrophy.
Symptoms
- Mid-epigastric pain radiating to the back, often after meals, lasting hours-days
- Steatorrhoea — bulky, oily, foul-smelling stools that float
- Unintentional weight loss despite normal appetite
- New-onset diabetes after years of pancreatic disease
- Fatigue, easy bruising (vitamin K), bone aches (vitamin D + osteoporosis)
When to discuss with a doctor
Persistent epigastric pain with weight loss and steatorrhoea warrants gastroenterology referral and imaging — chronic pancreatitis is under-diagnosed because the lab markers look normal. Treatment focuses on pain control, smoking + alcohol cessation, pancreatic enzyme replacement (PERT) for steatorrhoea, fat-soluble vitamin supplementation, and insulin for type 3c diabetes. Mediora.AI flags suggestive lab patterns (low vitamin D + B12 + abnormal HbA1c + low BMI); diagnosis requires imaging and a specialist.