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Gastroenterology  (Expert Forum)
 | 
Chronic Pancreatitis; Gastroparesis; IBS
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Chronic Pancreatitis; Gastroparesis; IBS

by 5fan, May 07, 2003 12:00AM
I have recently (finally) been diagnosed with Chronic Pancreatitis.  The diagnosis was not made until I underwent a secretin (spelling?) test in March.  At that time I was told that my bicarbonate level was within normal range, but that the amount digestive enzymes I produce is well below the normal range.  Unfortunately I cannot remember the amount I was told and I have not actually seen the doctor since I had the test done.  I don't go back to see him until 6/17.



I have also previously been diagnosed with gastroparesis; gastritis; IBS and a small hiatal hernia.  I am currently taking the following medications:



Librax (4X a day)

Nexium (40 mgs 2X a day)

Fibercon (3 pills 4X a day)

Viokase 16 (4 pills 4X a day)

Darvocet or Ultracet for the pain (Darvocet when I have a break

                                    through attack)

Ambien (as needed)

Erythromycin (1 and 1/2 Tsp - 4X a day)



Since beginning the Viokase approximately four weeks ago I have found that I have some relief with the pain in my back and my overall day to day pain/discomfort has improved.



My question is does chronic pancreatitis eventually lead to diabetes or is it possible that only one function of the pancrease is impaired?  



Any information or web pages with good research would be greatly appreciated.  I have been doing research off and on for the past 9 and 1/2 months since having an acute pancreatitis attack and having my gallbladder removed.  My liver and pancreas enzymes have pretty much returned to normal.  My liver enzymes ocassionally run over the high end of the scale, but not by much (a few points) and my surgeon explained that it may be that I am just one of the people who fall outside the standard scale.



I have not had an abnormal blood sugar test in more than 6 years and back then it was low.



I have never been a heavy drinker.  Until last June I probably had 12 drinks a year total.  I have had NO alcoholic beverages since June of 2002.  The doctor has told me that to the best of his knowledge my pancreatitis is ideopathic.  My tryglicerides are within normal range.  My trypsin level is outside the normal range, but not in the chronic range that is why I had the secretin test done.



If anyone can tell me any other possible "companion diseases/conditions" related to chronic pancreatitis I would appreciate it.  I'm trying to get a better picture of what to expect in the future before I go back to the doctor so I can ask him educated questions.



THANK YOU FOR ANY ASSISTANCE.

Doctor's Answer

by Kevin Pho, MD, May 09, 2003 12:00AM
Hello - thanks for asking your question.



To answer your questions:



1) Glucose intolerance occurs with some frequency in chronic pancreatitis, but overt diabetes mellitus usually only occurs late in the course of disease.



2) Chronic pancreatitis may be associated with a variety of complications. The most common are pseudocyst formation and mechanical obstruction of the duodenum and common bile duct; less frequent complications include pancreatic ascites or pleural effusion, splenic vein thrombosis with portal hypertension, and pseudoaneurysm formation, particularly of the splenic artery.  There may be an associated with pancreatic cancer.



3) Here are some relevant links:

NIDDK - Chronic Pancreatitis

http://www.niddk.nih.gov/health/digest/pubs/pancreas/pancreas.htm#chronic



Medline Plus - Chronic Pancreatitis

http://www.nlm.nih.gov/medlineplus/ency/article/000221.htm



Pancreas.org - Chronic Pancreatitis

http://www.pancreas.org/patients/patients_cp.html



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.

Member Comments (22)

by Pain7yrs, May 11, 2003 12:00AM
Hi,



So glad you posted your question! Would you mind emailing me to discuss some of your symptoms, especially the one dealing with the pain you mentioned that involves your back?  I have all the same problems you mentioned and I keep telling my gastro that there has to be something else causing my problem, but he keeps telling me to eat more fiber, walk, and drink more water.  I was doing all of that prior to my last little complication.  



How do I get my doctor to investigate something when he is absolutely convinced that it is as cut and dry as IBS, a huge Hiatal hernia, excess acid production, and my liver blood work comes back 'fine?'



Also, I would like to know about the 'secretin test' also.  



Thanks for any help you may be willing to offer.



***@****

by schaeff, May 12, 2003 12:00AM
To: pain7yrs
When a physician you are seeing becomes locked into one way of looking at your situation, and that perspective doesn't comport with your experience, or common sense, it's time to get another opinion.



I had two different GI doctors tell me that the excruciating, disabling pain, unlike any pain I'd ever had before, that occured every single day, 2-3 hours after every meal, and that began literally the day after I had my gall bladder removed, was "stress."  When I asked why my stress level would change so dramatically in only one day, they just shrugged.



A third doctor at a major medical center who wasn't locked into one way of looking at the problem had a different idea that has helped a lot.

by nadia, May 12, 2003 12:00AM
My doctor has been suspecting chronic pancreatitis as the cause of my pain.  However, when I recently had my amylase test done it came in at 30.  Is this within the normal range? She doesn't seem too sure about it.  She told me normal is 30-150.  I am living with constant pain in behind my sternum and it radiates into my back.

by TazLady, May 12, 2003 12:00AM
Hi,

First off, when did this site become a pay site?  I read where it might be, but to post a question is now 15.00.  I had no idea it changed.  I knew the Dr.s personal page was a pay site.



Second, has anyone on here that has been diagnosed with any form of Pancreatitis taken any diet suppliments?  I have Idiopathic Severe Chronic Pancreatitis.  I want to lose some weight and excersizing alone is not doing it due to the meds I take.



Thanks,

TazLady

by 4gpact, May 14, 2003 12:00AM
I am not sure if your comment about the gastroparesis diagnosis was meant to mean that it was correct or not? If you do have it,

there is a medication that might also help your other symptoms. It is called domperidone. I have to order it from outside the US, because it is not sold here. However, it is a wonderful medication, and I have taken it for awhile now with good results. It helps the stomach to empty better, and helps with things like nausea, bloating, etc. I would imagine that is why you are taking the erythromycin, that is another med used to treat gastroparesis. If it is NOT working for you, ask your doctor about trying the domperidone. You may want to consider seeing a gastric