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Many patients with chronic pancreatitis (CP) find that by taking pancreatic enzymes orally, they are able to achieve improved digestive function. Pancreatic enzymes also help to increase absorption and reduce steatorrhea. It is still not clear whether pancreatic enzymes also reduce pain. The enzymes, available in capsule form, should be taken with food.

Some of the commercially available pancreatic enzyme capsules include:

• Creon
• Pancrease
• Viokase

In addition to pancreatic enzymes, the physician may also suggest that the patient take:

• Acid suppression medication, such as histamine H2 blockers or proton pump inhibitors. This prevents destruction of the enzymes by gastric acid.
• Vitamin supplementation for low levels, especially vitamin D. Vitamin D is related to bone density and low levels can lead to osteoporosis. Some clinicians recommend that patients have a bone density scan to check for osteoporosis. Other vitamins that may need to be supplemented include vitamins E, K, and B12.

Nutrition is a significant issue for patients with pancreatitis. The combination of poor nutritional intake due to pain and poor absorption of nutrients carries a high risk of malnutrition. Patients with chronic pancreatitis often must alter their food intake in order to optimize absorption of food and minimize pain associated with eating. Towards this goal, patients should modify their diet to several small meals a day instead of three large meals. The diet should be high in carbohydrate and low in fat to minimize the amount of enzymes needed for digestion. For malnutrition, patients may also be directed to eat a high protein, high calorie diet.

If the patient is unable to eat, nutrition can be provided in a number of ways. A guiding principle of nutrition management is to use the digestive tract whenever possible. Therefore, formula feedings can be provided through a variety of tubes (nasojejunal, percutaneous endoscopic gastrostomy, and surgical gastrostomy with jejunostomy) which enter the gastrointestinal tract and maximize natural digestion. When this is not possible or if treatment involves total rest for the digestive tract, total parenteral nutrition through a central venous line may be considered.

Peptamen is an elemental liquid diet that is being studied as an alternative source of nutrition while avoiding abdominal discomfort in patients with pancreatic disease.

It is essential that patients with alcohol-induced chronic pancreatitis avoid further alcohol intake and anyone with any type of CP cease smoking immediately.

It is also important for patients with chronic pancreatitis (CP) to adhere closely to the recommendations of a doctor regarding the development and management of diabetes.