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Chronic pancreatitis.

Dear Dr. SerVaas,

I have had chronic pancreatitis for many years. The attacks are frequent, with severe pain and nausea. I have been hospitalized many times and am on a low-fat diet. I will appreciate any information you can provide about this condition.

Meryl Patterson

Sherborn, Massachusetts

We sent your letter to Dr. Walter Coyle, gastroenterology program director at Scripps Clinic Torrey Pines in LaJolla, California. Dr. Coyle responds:

"Unfortunately, you are not alone. More than 60,000 admissions per year to U.S. hospitals are associated with chronic pancreatitis.

"The pancreas is an organ in your abdomen that is critical to digestion and control of blood sugar. In chronic pancreatitis, the pancreas is damaged and becomes progressively scarred. It often becomes calcified and may contain stones and cysts. In this country, about three quarters of cases are due to alcohol use. Other major causes include hereditary (genetic) diseases, metabolic problems such as high calcium or triglyceride levels, abnormalities or blockages of the pancreatic duct, and autoimmune diseases. Sometimes, the cause is unknown.

"The first key to treatment is eliminating the cause, if possible. This could mean abstaining from alcohol, treating high calcium or triglyceride levels, fixing blockages, or treating the autoimmune disease. Some newer studies suggest that taking antioxidants like vitamin E may help prevent attacks, but there is not yet solid proof. Once the pain and nausea start, however, these measures often do not alleviate symptoms.

"Traking pancreatic enzymes by mouth aids digestion and sometimes helps relieve pain and bloating- Moderate to severe pain usually requires the use of narcotics. Newer nonnarcotic medications can blunt the pain response and reduce the need for high-dose narcotics. On occasion, gastroenterologists can treat pain with new endoscopic treatments to unblock the drainage ducts, remove stones, or drain cysts. Pain specialists may block the main nerve involved, which is called the celiac plexus. In rare cases, we resort to surgery to remove part of the diseased organ or drain the duct.

"Doctors experienced in pancreatic diseases are best equipped to treat moderate-to-severe chronic pancreatitis. I encourage you to seek out a medical center that specializes in diseases of the pancreas."
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Title Annotation:MEDICAL MAILBOX
Publication:Saturday Evening Post
Geographic Code:1USA
Date:Nov 1, 2008
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