Stone has to go, but that may not stop pan­cre­ati­tis

The Daily Courier - - LIFE & ARTS - KEITH ROACH

DEAR DR. ROACH: I am 57 and gen­er­ally in good health. My doc­tor di­ag­nosed me with chronic pan­cre­ati­tis af­ter I had weight loss with di­ar­rhea and was found to have fat in my stool. The CT scan showed that I have a 12mil­lime­tre stone block­ing my pan­cre­atic duct. He said I have chronic pan­cre­ati­tis. My doc­tor says I need surgery to re­move the stone.

Is this a life-or-death surgery? If no one will per­form the surgery, is there an­other way to get rid of the stone?

AN­SWER: Chronic pan­cre­ati­tis is a rel­a­tively com­mon con­di­tion but some­times can go for a long time with­out be­ing di­ag­nosed. The pres­ence of fat in the stool is a big clue to the di­ag­no­sis: Pa­tients may no­tice that their stools seem oily, and it might take mul­ti­ple flushes of the toi­let to com­pletely re­move it. The di­ar­rhea hap­pens be­cause the pan­cre­atic en­zymes are nec­es­sary for the body to ab­sorb fat: With­out the pan­creas, the fat passes all the way through the body, caus­ing fatty di­ar­rhea, called steat­or­rhea. Many peo­ple have ab­dom­i­nal pain, some­times episodic, but at least 20 per cent of peo­ple have none.

There are many causes of chronic pan­cre­ati­tis. Chronic al­co­hol abuse is the most com­mon cause that I saw in my train­ing, but ob­struc­tion of the pan­cre­atic duct by stone or tu­mour is an­other. Un­for­tu­nately, re­mov­ing the stone might not stop the pan­cre­ati­tis: In many peo­ple, the changes in the pan­creas from long­stand­ing ob­struc­tion are ir­re­versible. Nonethe­less, I whole­heart­edly agree with re­mov­ing the cause of the ob­struc­tion.

There are sev­eral ap­proaches to re­mov­ing a pan­cre­atic stone, in­clud­ing en­do­scopic re­moval, laser treat­ment and shock wave lithotripsy (us­ing sound waves to break up the stone). Only your treat­ing physi­cian can say what the best treat­ment for you is.

Although any of th­ese may be con­sid­ered “surgery,” there also are sur­gi­cal treat­ments for chronic pan­cre­ati­tis, and I’m not sure if your doc­tor is rec­om­mend­ing one of those. Surgery for chronic pan­cre­ati­tis (as op­posed to re­mov­ing the stone) usu­ally is used for peo­ple whose pain can’t be con­trolled.

An­other im­por­tant treat­ment in chronic pan­cre­ati­tis is the use of re­place­ment en­zymes. Th­ese help digest the fat and pro­tein in the food, re­liev­ing the di­ar­rhea and, in some peo­ple, re­liev­ing pain. They also can help the body ab­sorb fat-sol­u­ble vi­ta­mins.

Email ques­tions to Dr. Roach at ToYourGoodHealth@med.cor­nell.edu.

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