Could this be Chronic Relapsing Pancreatitis

In 1982 I underwent a transduodenal sphincterplasty of the Sphincter of Oddie for the diagonisis of a stenotic pancreatic duct.   Symptoms were burning abdominal pain radiating into my back at waist level beginning approximately 20 minutes after eating. Sometimes the pain caused vomiting with trips to the emergency room.

Remained pain free for several years but burining pain started again after meals. Ductal manometry (sp?)  revealed I had a spasming pancreatic duct.  This was treated with nefedipine (sp?) and improved temporarily but, but this burining pain has continued to occur sporadically throughout my life.  It has not kept me from living a full and productive life but when it occurs it has slows me down and sometimes stops me in my tracks.

The doctors have been reluctant to do another ERCP, I concurred, because of an attack of acute pancreatitis after the manometry/ERCP, but I have had many CAT scans, several MRIs, and one internal abdominal ultrasound in 2001.  My most recent CAT scan was spring of 2007.  It was normal.  The only abnormal finding was seen during the ultrasound and it was attributed to aging.  Despite normal results I continue to have intermittent pain and now my burning pain has extended to the groin area.   All pain is less when I wake up and is worse after I eat.

I have been doing internet research and discovered that chronic relapsing pancreatitis does not show up in lab tests until most of the pancreas is damaged. Do you think, based upon my long history, there is a chance this could be my problem? I have accepted living with pain for the months it occurs, but am more concerned now because of the change in my symptoms which now includes the groin pain. When blood tests and others are normal, doctors seem to assume  there is no problem.  

I appreciate any thoughts or suggestions you might have.

Nancy2742

        

[Kevin Pho, MD]

I cannot speculate nor give a probability without evaluating you or your personal records.

There are several tests can you can consider to further evaluate the pancreas.  An MRCP can be considered to non-invasively image the biliary and pancreatic ducts.

You can also obtain detailed imaging of the pancreas with an MRI or endoscopic ultrasound.

If the duct continues to spasm, one option would be an injection of Botulinum toxin, which has been used in some small studies.

These options can be discussed with your personal physician or GI consultant.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[Nancy2742]

Thank you for your comments.  You have mentioned several tests that I have not had for which I am grateful.  This has a painful and frustrating experience because I do not want to take pain medication other then asprin because of the danger of addiction.  

My understanding is that chronic pancreatitis is very difficult to diagnose because there is no test that will diagnose it.  Is this accurate?

I do appreciate your prompt reply and look forward to your answer to this question.  What I really want to know is do the tests you mentioned diagnose chronic pancreatitis with certainty?   I have been through so many tests that I don't want to have more unless they are definitive.  Thanks again,

Nancy

[s123]

Just spotted your post.  There is a Pancreatitis Supporters Network forum here in the UK, if you'd like to google it.  It has a wealth of information on both acute and chronic panc. and related disorders, and very helpful members to whom you might introduce your query.  Do hope this is of use.  Best wishes to you.

[Nancy2742]

Thank you for taking the time to let me know about the support group.  I will definitely be in touch.

Kindest regards,

[s123]

V. pleased my comment helped.  Hope you will have no trouble locating the website.  For general discussion, click on Community, where it is divided into General Support and General Chat.  Forgot to mention that there are a number of members from the US also.  

Hope pain not too tough today.

With best wishes to you.