What Is Pancreatitis?
Pancreatitis is inflammation of the pancreas, an organ that produces digestive enzymes and hormones (insulin and glucagon). Acute attacks of pancreatitis usually subside within several days to a week but carry the risk of life-threatening complications, including shock and infection in a collection of fluid near the pancreas (pseudocyst). Chronic pancreatitis involving permanent damage to the pancreas may follow recurrent attacks of acute pancreatitis or be due to persistent smoldering inflammation. Possible long-term complications include inadequate absorption of nutrients and diabetes mellitus.
Who Gets Pancreatitis?
Pancreatitis occurs more often in adults who have a history of alcohol abuse and in patients who have gallbladder disease (e.g., gallstones). According to the National Institutes of Health (NIH), approximately 80,000 cases of acute pancreatitis occur each year in the United States and about 20% of these cases are severe and life threatening.
Rates of recurrent attacks and chronic pancreatitis are difficult to determine. Approximately 70% of chronic cases in adults are related to alcohol abuse. Chronic pancreatitis is more common between the ages of 30 and 40.
Pancreatitis affects men more often than women and is more common in African Americans than in Caucasians. The condition is rare in children.
- Acute disease: moderate to severe abdominal pain that may spread to the chest, back, and sides (and is often worse when lying down); nausea and vomiting; abdominal bloating; mild fever; clammy skin.
- Chronic: constant or episodic abdominal pain; weight loss; bulky, floating stools.
- Pancreatitis often causes anxiety, distress, and other signs, such as low blood pressure, rapid heart rate, and rapid breathing rate (i.e., respiration). The condition also can cause serious complications that can be life threatening.
Complications include the following:
Bleeding (may cause shock).
Dehydration (excessive loss of body fluid).
Organ failure (e.g., difficulty breathing, kidney failure, heart failure).
Pseudocysts (accumulations of damaged tissue and fluid that collect in the pancreas, the pancreatic duct, or the surrounding area).
Tissue damage (necrosis).
Passage of a gallstone that blocks the pancreatic duct is often a cause of acute attacks.
Alcoholism is commonly associated with both acute and chronic pancreatitis.
Tobacco smoking is associated with the development of pancreatitis and progression to pancreatic cancer.
Less common causes of acute attacks: trauma to the pancreas; use of certain drugs (including immunosuppressants, corticosteroids, and sulfa drugs); high triglycerides; viral infection such as mumps.
Other causes of chronic pancreatitis: recurrent acute pancreatitis; cystic fibrosis (children); malnutrition.
In rare cases pancreatitis is hereditary.
In many cases the cause cannot be determined.
Other pancreatitis risk factors in children and adults include the following:
- Bacterial infections such as Mycoplasma, Campylobacter).
- Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP).
- Metabolic disorders such as hyperparathyroidism.
- Obstructions in the biliary system.
- Peptic ulcer (occurs in the lower end of the esophagus, the stomach, or the duodenum).
- Systemic lupus erythematosus.
- Viral infections such as mumps or coxsackievirus.
Certain medications also can increase the risk for pancreatitis. These drugs include:
- Azathioprine, 6-mercaptopurine (Imuran), an immunosuppressive drug used to treat rheumatoid arthritis and following organ transplant.
- Diuretics such as furosemide (Lasix), used to reduce edema (swelling) in patients who have chronic heart failure (CHF), liver disease, and kidney disease.
- Didanosine or ddI (Videx), used to treat HIV infection.
- Estrogens (oral contraceptives), used to prevent pregnancy)
- Pentamidine (Nubupent), used to treat some types of pneumonia.
- Tetracycline (Sumycin), an antibiotic used to treat bacterial infections.
- Valproic acid (Depakene), an anticonvulsant used to treat complex partial seizures.
- During a physical examination, the doctor looks for signs of pancreatitis, including abdominal pain and bloating, low blood pressure, fever, and rapid heart rate.
- Pancreatic function tests (e.g., blood tests, urine tests, stool tests) can detect abnormal levels of pancreatic enzymes (e.g., amylase, lipase), glucose (blood sugar), white blood cells (WBCs), and other substances (e.g., sodium, calcium, potassium), which can indicate pancreatitis.
- X-ray, ultrasound, CT (computed tomography), and MRI of the abdomen can be used to detect infection or inflammation of the pancreas, congenital abnormalities, gallstones, and pseudocysts (accumulations of fluid and damaged tissue).
- ERCP (endoscopic retrograde cholangiopancreatogram) is done using a thin, lighted, viewing tube (endoscope) passed down the throat and into the small intestine. Contrast material is injected into the bile duct and pancreatic duct and x-rays are taken. An internal ultrasound called EUS is very sensitive to diagnose pancreatitis. It is used frequently in early chronic pancreatitis, which is otherwise hard to diagnose.
- Stool (for fat content or levels of a pancreatic enzyme called elastase), pancreatic-function, and other tests help confirm chronic cases.
- Other conditions, such as peptic ulcer, gallbladder inflammation (called acute cholecystitis), and intestinal obstruction often must be ruled out to make a definitive diagnosis.
Acute attacks require hospitalization. The stomach is emptied of its contents, and intravenous fluids and painkillers are given. Patients are not allowed to eat for several days to a week. Antibiotics may be given to treat an associated infection.
Surgery to remove gallstones may be necessary.
Narcotic painkillers may be needed for severe pain.
Alcohol and large, fatty meals should be avoided by those with the chronic form of the illness.
Damage to the pancreas may prevent secretion of digestive enzymes and lead to malabsorption. Therefore, pancreatic enzyme pills are usually prescribed for patients with chronic pancreatitis, to aid in digestion.
Insulin may be needed if diabetes develops.
Chronic pancreatitis occasionally requires partial or total removal of the pancreas (pancreatectomy) or surgery to deaden the nerves that transmit the pain. In some situations, the islet cells of the pancreas are then transplanted into the patient so those hormones, such as insulin, are still made. Otherwise, hard-to-control diabetes will occur.
The U.S. Food and Drug Administration (FDA) has approved pancrelipase (Viokace) to treat chronic pancreatitis in adults. This medication is used in combination with a proton pump inhibitor and also is approved for adults who have had part of their pancreas removed. Other pancreatic enzyme supplements approved by the FDA include Creon, Zenpep, Pancreaze, Ultresa, and Pertyze. Ultresa is approved for use in children and adults with cystic fibrosis who cannot digest food normally because the pancreas does not produce adequate pancreatic enzymes.
The prognosis (expected outcome) for patients who have pancreatitis depends on the age and overall health of the patient, and the severity of the condition. In mild cases, the prognosis is good. The prognosis is much, much better in patients who stop smoking and stop drinking alcohol.
Complications, such as severe tissue damage, infection, organ failure, diabetes, and shock, often result in a poor prognosis. According to the National Institutes of Health (NIH), the death rate may be as high as 10–50% in patients who develop severe complications (e.g., organ failure).
Pancreatitis cannot be prevented in all cases. To help reduce the risk for developing the condition, drink alcohol only in moderation, do not smoke, and eat a healthy diet that is low in fat.
When To Call Your Doctor
Call a doctor if you have symptoms of pancreatitis.
Reviewed by Jenifer K. Lehrer, M.D., Department of Gastroenterology, Aria-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.