duration of time between attacks

[indian sam]

In 1978 I had acute postoperative pancreatitus (pancreatitis).  My diagnosis according to the us navy doctors, was acute gallbladder attack.  My Acute Abdominal Series was normal at that time.  I had no further symptoms of pancreatitus (pancreatitis) until 2001.  My condition is considered acute and transitory, by a disabilty rating board.  Since 2001, I have been hospitalized at least a dozen times if not more and the diagnosis has always been chronic pancreatitus (pancreatitis).  I had an ercp that put me into a full blown attack and yet another that found no obstructions.   I have had cysts on my pancreas the size of eggs.   I have had my lipase levels one hour sky high and the next back to normal and then the next back up.  My symptons are always the same, Severe back pain, pain on the right side of my stomach, the pancreas swollen and very painful, diarhea (diarrhea), vomiting etc;  The attacks are unpredictable coming and going at will.  It is apparent that the attacks are not preventable and only the results of the attacks are treatable  {I do not drink}  My question is as follows; Since I have not had any attacks for over 26 years, is it possible that I have had chronic pancreatitus (pancreatitis) all these years and it took something like food, drink, medication or even stress to set the attacks off again?

[Kevin Pho, MD]

The scenario that you have described is possible with chronic pancreatitis.  Certainly, medications or alcohol can cause pancreatitis.  Here is a list of some other causes:

   Alcohol abuse
   Hereditary pancreatitis
   Ductal obstruction (eg, trauma, pseudocysts, stones, tumors, possibly pancreas divisum)
   Tropical pancreatitis
   Systemic disease such as systemic lupus erythematosus, cystic fibrosis, possibly hyperparathyroidism
   Autoimmune pancreatitis
   Idiopathic pancreatitis
   Mutations of the cystic fibrosis gene

Further evaluation can be done with an MRCP or endoscopic ultrasound if the ERCP is not-revealing.  If there continues to be pancreatic pain, you may want to consider discussing whether pancreatic enzyme supplementation can help - it has been shown in studies that supplementation can help the pain associated with chronic pancreatitis.

Followup with your personal physician is essential.

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

Thanks,
Kevin, M.D.

Bibliography:
Freedman.  Etiology and pathogenesis of chronic pancreatitis.  UptoDate, 2004.

[PETIE233]

A related discussion, PANCREAS SURGICAL TRANSPLANT was started.