this is for anyone who knows

[Guest guest]

i have had a eus and a ercp and both test should that i do not have

cp but the treatment has helped i taked viokase 16 and anti acid and

norco my symptoms are exactly the same is it possible to have cp and

not have a severe enough case to have scarring that can be seen ? i

am young and had a severe attack when i was sixteen and it runs in my

family any opionion would be greatly apreciated

sara

[Guest guest]

Hi Sara. Having an EUS and ERCP that shows no signs of chronic

pancreatitis is a good thing. Really. What that means is that you

do not have the signs and symptoms of CHRONIC pancreatitis. That

does not mean that you did not have an attack of pancreatitis at one

time.

Chronic pancreatitis is defined as recurrent attacks of acute

pancreatitis. Acute attacks do not necessarily mean that a person

will get chronic pancreatitis. However, it is a great big giant red

flag and is something that should be monitored. Continue to take

the meds as the doctor prescribed. Have checkups frequently. Dont

drink any alcohol. Eat a low fat diet. And try to relax, stress

can sometimes be our worse enemy.

Like I said it great news that you dont have any scarring or other

signs of cp. I will hope and pray that it stays that way for you

for a very long time. If there is anything else we can do, please

dont hesitate to ask. I hope you feel better soon and keep in

touch, this board is a wonderful place to find support and

understanding from people who know how you feel.

Warmly,

[Guest guest]

Hi Sara,

It is quite common to have symptoms of chronic pancreatitis

before you show overt signs. It is thought that early chronic

pancreatitis is basically just that: symptoms (pain, nausea /

vomitting, diarrhea / constipation, etc) without the overt signs that

are detected by EUS and ERCP (dilatation, calcifications,

strictures, pseudocysts, obstructions, etc). Some pancreas

specialists believe that it is common to have symptoms up to 10

years before having signs (although one paper I just read puts it

at 4 years). So yes, it is possible to have CP without having overt

signs noted by EUS and ERCP. Usually a good pancreas

specialist will give you a (tentative) diagnosis based on medical

history, physical exam and the procedures that you mentioned.

There are certain family and personal history that can suggest a

diagnosis. The fact that you have pancreas problems running in

the family can suggest that you may have a form of hereditary

pancreatitis. And the doctor will run tests to rule out other more

obvious causes of abdominal pain and acute pancreatitis like

gallbladder problems, biliary or liver problems, bowel

diseases....etc. It is usually a long and frustrating process.

In addition, you should learn about the differences between

acute pancreatitis and chronic. The first thing you will learn is

that issues regarding chronic pancreatitis are very controversial

and not clear cut. One thing is the relationship between acute

attacks and the progression to chronic. It is thougt that there is a

low chance that acute pancreatitis will progress to chronic.

Morphologically, the two diseases are very different and it is

thought that distinct processes are involved in the development

of each. Basically, the initiating factor that causes acute

pancreatitis can usually be found and treated. However, this

may not be so for CP.

Clinically, distinguishing between the two can be difficult.

However, one thing that is important to know is that acute

pancreatitis is usually quick to occur, is severe enough to need

inpatient care, can be life-threatening and almost always shows

raised amylase and lipase elevations. Most people will recover

completely from a single attack of acute pancreatitis if the reason

for it occuring is eliminated. If the cause is not found, some

people experience what is called relapsing acute pancreatitis. It

is unknown if this is the patient who goes on to develop chronic

pancreatitis from acute episodes - some docs believe that this is

a route, others do not.

Chronic pancreatitis, on the other hand, can develop in people

who have never had one episode of acute, is usually very painful

but the pain may have developed over a long period of time, but it

can have pain spikes and flares which can be similar to acute

pancreatitis (hence the reason why AP may be hard to

distinguish from CP clinically). CP damage does not resolve and

will most likely progress to ever worsening conditions,

depending on the etiology. In addition, amylase and lipase

elevations may not be elevated. It is thought that this is so

because the destruction of CP is focal, thus the rise in enzymes

is seen only in a localized area and do not get into the blood

stream to any significant extent and / or that where the focal

destruction is taking place the cells are no longer able to

produce enzymes so by destroying those tissues, no enzymes

are released so no elevations in the blood are seen. This is very

different from the mechanism seen in acute pancreatitis - at

which time the destruction is occuring thoughout the pancreas

and that prior to the acute attack, the pancreas is healthy enough

to be able to synthesize enzymes.

Chronic pancreatitis can be caused by alcohol ingestion,

hereditary traits, ductal obstruction, systemic disease (like CF,

SLE, etc) as well as being idiopathic. It is thought that what all of

these disorders have in common is the that they initiate two

events: a decrease in bicarbonate secretion due to either

mechanical or functional ductal obstruction; and the

intraparanchymal activation of digistive enzymes. These two

events cause the pain and destruction of the pancreas.

So yes, CP can be occuring without signs being detected by

ERCP and EUS. It is thought that it is most likely a very early

stage of CP in which the disease process is taking place at the

cellular and molecular level and it has not progressed to the

point of showing overt changes in the pancreas ducts or

paranchyma. If you were to follow the disease over the years (do

repeat ERCPs / EUSs at 5 and ten year intervals) if it is truly CP,

signs will most likely begin to appear unless you are lucky

enough to slow down the process to almost a standstill.

Laurie