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Featuring Vikesh Singh, M.D., M.Sc., Assistant Professor of Medicine; Director, Pancreatitis Center
I am Vikesh Singh. I am a gastroenterologist at Johns Hopkins. I am the Director of the Pancreatitis Center and I am the Medical Director of the Islet Auto Transplantation Program. I specialize in inflammatory disorders of the pancreas as well as interventional endoscopy.
Chronic pancreatitis is a long-standing inflammatory disorder of the pancreas, which results in gradual and progressive fibrosis of the gland, and that ultimately results in three common complications, which include chronic abdominal pain, exocrine insufficiency, as well as endocrine insufficiency. Chronic abdominal pain is the primary reason that patients seek medical attention for this problem. However in the later stages of the diseases, the exocrine insufficiency, which is typically manifested by voluminous diarrhea and endocrine insufficiency which is commonly known as diabetes often set in and these or other conditions typically need to be managed as part of the care of these patients.
Acute pancreatitis is a sudden inflammation of the pancreas which typically catches people off guard and its most commonly manifested by severe abdominal pain which requires medical attention. These patients typically present to emergency rooms and after the diagnosis, which is based on simple blood tests and sometimes a CT scan of the abdomen, these patients are usually admitted. They are given nothing by mouth. They are given IV fluids as well as pain medication. What typically sets apart acute from chronic pancreatitis is that acute pancreatitis usually gets better with these conservative measures. Chronic pancreatitis is really what sets in over a longer period of time with continuous bouts of acute pancreatitis.
There aren’t any other types of pancreatitis, but there are other forms of pancreatitis that can result in acute and chronic inflammation. Probably the one we most commonly think of is autoimmune pancreatitis where the body itself is attacking the pancreas and that leads not only to acute inflammation but over some period of time, it can also cause the changes of chronic pancreatitis. But other than that, there are no other true, pathologic forms of pancreatitis.
The diagnosis of chronic pancreatitis involves a combination of testing modalities. One is often a clinical history, but in addition to that, the physician might employ a range of tests including simple blood tests, stool tests, imaging studies and endoscopic procedures. Diagnosing moderate or severe chronic pancreatitis is actually very, very easy. A simple imaging study typically reveals changes in the gland which are common for chronic pancreatitis. In the earliest or mild stages of the disease, that is where the most difficulties are in diagnosing chronic pancreatitis. These are the patients who often have abdominal pain that’s chronic in nature and maybe quite debilitating, even to the point where they often require narcotics. However, pursuing simple imaging studies of these patients usually reveals a normal pancreas. It is those patients who, I think, form the greatest challenge for their providers. And I think that it’s those patients who are probably best served by being referred to a tertiary center where they can undergo more complex testing and evaluation in order to figure out whether they might really have mild or early chronic pancreatitis.