You wrote:

"Current medical status: was diagnosed 1/30/06. GI has prescried enzymes, do not seem to help. Experience constant pain in pancreas area. eat very strict vegetarian diet with no fat. Do eat fish. Drink no alcohol. Lipase level 54-56. We nt to Mexico for alternative treatments. Lipase level brought down to 16.7, pain went away. Returned to Boston after 6 days lipase level 55 pain returned, HELP

Current medical treatment: One enzyme or another no help"

Chronic pancreatitis is a prolonged inflammation of the pancreas which is characterized by permanent damage of the anatomic structures of the pancreas which manifests with frequent functional failures even after elimination of the causes. In the final stadium of the disease there is a complete functional failure of both the endocrine and exocrine areas of the pancreas.
Causes for occurring chronic pancreatitis are:
1. Alcohol abuse (90% of cases);
2. Unknown reason (5% of cases), and
3. Congenital pancreatitis, hyperparathyroidism and cystic fibrosis (the remaining 5% of all cases).

Small excretory canals of the pancreas become obstructed and pancreatic enzymes get activated in the pancreas itself instead in the small intestinal lumen. Early activation of the pancreatic enzymes causes inflammation and damage of the pancreatic cells. In time, the pancreas will fail to create its exocrine (which is responsible for food digestion in the intestines) and endocrine (blood glucose regulation) functions.

The dominant symptom present during chronic pancreatitis is upper abdominal pain that worsens from time to time. Lack of the enzyme "lipase" causes fats to be eliminated through the stool (steatorrhea) rather than being absorbed into the body. In time, mellitus can occur due to decreased secretions of insulin and this condition presents symptoms of secondary diabetes . Symptoms of vitamin deficiency (A, D, E, K and B) can also occur.

There are several diagnostic procedures used to confirm chronic pancreatitis:
1. Laboratory analyses: Blood analyses (increased lipase, amylase and phospholipase A and latter glucose), stool analyses (fats and elastasa present), positive PABA-test in the urine, positive secretin-test.
2. X-ray image of the abdomen shows calcifications in the pancreatic region;
3. Abdominal ultrasound is the most valuable method that can show calcules in the pancreatic canals;
4. Endoscopic Retrograde Cholangio-Pancraticography (ERCP)- visualizes the billiary and pancreatic duct and is obvious before a decision is made for surgical treatment or not;
5. Endoscopic ultrasound, and
6. Fine needle biopsy under ultrasound control.

Treatment therapy for chronic pancreatitis includes:
1. Taking enzymes to compensate for pancreatic failure and to decrease irritation and secretion of enzymes by the pancreas;
2. Taking H2-blockers to decrease stomach acidity;
3. Endoscopic treatment of the pancreatic obstruction by putting protease in the pancreatic canal or breaking the calculus with lithotripsy or laser;
4. Treating diabetes, and
5. Surgical treatment when pains become severe and intervention endoscopy failed to help.