How to manage abdominal pain in chronic pancreatitis?

Question

Hello doctor,

I have chronic pancreatitis and have been on ERT (enzyme replacement therapy) for the last six years. I had my gall bladder removed seven months ago due to sludge. I had gastritis in endoscopy and Helicobacter pylori seven weeks ago and took eradication therapy.

I still have random pains after dinner despite watching my food habits; nothing else in EUS (endoscopic ultrasound), MRCP (magnetic resonance cholangiopancreatography), or ultrasound.

Could it be acid or bile causing pain?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

I have reviewed your case history in detail and attached endoscopy and EUS (endoscopic ultrasound) reports, too.

So,

Random pains in chronic pancreatitis, in the absence of acute or chronic pancreatitis (normal lipase levels), are likely neuropathic in origin. Pain nerves within pancreatic tissue have been damaged with a chronic process of inflammation leading to chronic pancreatitis; their response to simple stimuli can be verified, or one can say they preserved abnormal pain sensation even without painful stimulation.
Above is a likely explanation in your case; gastric was not that severe, which can explain recurrent pain, especially when you have treated Helicobacter pylori already. Diffuse gastritis usually reduces appetite, nausea, bloating, etc., rather than episodic sharp pains.
It is not related to food as such; that is the reason why you are taking all necessary precautions but still ineffective.
Pregabalin is a good medicine for such pains, and I think one can increase the dose if necessary.
Regarding pancreatic supplements, the dose should be appropriate too; this will prevent further burden on chronic pancreatitis and may help in reducing painful episodes.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

So,

For stomach inflammation, the definitive tests are endoscopy and biopsy, as well as clinically proton pump inhibitors trials like tablet Pantoprazole 40 mg a half hour before breakfast or any meal once daily for two weeks. Such medicines are very good acid suppressors and should relieve pain. If it relieves pain, it means gastritis has been resolved.
For pain in pancreatitis, such as acute or chronic pancreatitis, serum lipase is very specific for the pancreas, and during painful episodes, one can consider it if the pain is moderate to severe intensity.
You can take antacids if the pain is not increasing and you are responding to it. The likely cause is the stomach rather than the pancreas.
Bile reflux can be better diagnosed on endoscopy. Not every post-cholecystectomy (a collection of symptoms that occur after gallbladder removal surgery) patient will develop this.

Well, the treatment will still be the same PPIs (proton pump inhibitors) and antacid syrups.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.