Chronic Pancreatitis - Pancreatic Pathologies by Cincinnati Children's Pancreas Care Center

Ongoing damage in chronic pancreatitis affects acinar cells, ductal cells, and islet cells which are responsible for producing insulin.

When islet cells which produce insulin are damaged by chronic pancreatitis, it can lead to endocrine issues such as diabetes.

Chronic pancreatitis is a progressive inflammatory disorder that results in irreversible loss of pancreatic function.

Diagnosis of chronic pancreatitis involves identifying calcifications, ductal obstruction, or dilation combined with one of three criteria: pain consistent with pancreatic origin, exocrine dysfunction, or endocrine dysfunction.

In adults, CT with IV contrast often includes multiple phases (non-contrast, arterial, and portal venous), but this is avoided in children because it markedly increases radiation dose without providing much additional diagnostic information.

According to Dr. Trout, arterial phase imaging is reserved for specific questions about arterial pseudoaneurysms or when characterizing potential masses.

At initial characterization of a patient with acute recurrent or chronic pancreatitis, IV contrast can be useful to understand vascular complications or fluid collections, but in many cases MRI exams can be done without IV contrast.

Cincinnati Children's has an in-house 10-gene pancreatitis risk panel to screen for genetic links to pancreatitis.

For pancreatic enzyme replacement, cystic fibrosis guidelines are followed for dosing, and enzymes are reserved only for cases with documented exocrine pancreatic insufficiency.

Endoscopic therapy for chronic pancreatitis relies on two methods: endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).

Pain management in chronic pancreatitis follows a stepwise ladder approach, starting with opiate-sparing medications and reserving opiates for severe pain cases.

Opiate-sparing chronic pain medications include neuropathic medications like amitriptyline and gabapentin, usually prescribed in partnership with a pain specialist as part of multidisciplinary management.

At Cincinnati Children's, cognitive behavioral therapy (CBT) is incorporated in multidisciplinary pain management and has been shown in other chronic conditions to be helpful in managing pain.