Pancreatitis

Pancreatitis is a condition that occurs when the pancreas, which is a gland located behind the stomach and near the liver, becomes inflamed. The pancreas produces digestive enzymes which are needed to digest food and insulin which is needed to control blood sugar. When the pancreas is inflamed, it releases its own enzymes (which are usually stored inside the organ) causing damage to the pancreas and surrounding structures. 

There are two forms of pancreatitis. The acute form occurs suddenly and can be very severe and lead to death. After successful treatment of acute pancreatitis, the gland usually recovers completely. Chronic (long term) pancreatitis occurs when there is continuous damage to the pancreas that can lead to ongoing pain and a permanent decrease in its function. 

What causes pancreatitis?

Acute pancreatitis is mainly caused by gallstone obstruction of the pancreatic duct or by alcohol. Other causes include certain drugs, high levels of fat, viral infections such as mumps or in some cases it may run in families. Chronic pancreatitis is mainly caused by chronic alcohol intake in adults or cystic fibrosis in the young. In some cases pancreatitis is genetic. Obesity is a well-known risk factor for developing severe, acute pancreatitis. The “obesity epidemic” of the western world will likely increase the total number of patients within the next few decades.

Both acute and chronic pancreatitis cause pain, usually in the upper abdomen. Typically pain spreads straight to the middle of the back. It may come on after heavy alcohol use or eating. It is frequently accompanied by nausea and vomiting. It is worse when lying flat and better when bending forward. In severe cases there may be fever, sweating, fast heartbeat, lightheadedness and fainting. It can lead to heart, lung and kidney failure and ultimately death.

When the pancreas is continuously damaged, such as with persistent drinking of alcohol, chronic pancreatitis may develop. There may be continuous pain, loss of weight, diarrhea and the development of diabetes.

The diagnosis of acute pancreatitis is made from the medical history and symptoms. During the attack, a blood test may show a high level of amylase or lipase (digestive enzymes formed by the pancreas). Other blood tests may show abnormal blood sugar, calcium or fat. These blood tests usually return to normal after an attack. Other tests include X-ray of the abdomen and chest, an ultrasound or a CT scan of the pancreas and the gallbladder.

The diagnosis of acute pancreatitis is made from the medical history and symptoms. During the attack, a blood test may show a high level of amylase or lipase (digestive enzymes formed by the pancreas). Other blood tests may show abnormal blood sugar, calcium or fat. These blood tests usually return to normal after an attack. Other tests include X-ray of the abdomen and chest, an ultrasound or a CT scan of the pancreas and the gallbladder.

Treating pancreatitis

Patients with acute pancreatitis are usually admitted to hospital where they are kept without eating or drinking. They receive fluid through a vein (intravenous). This allows the pancreas to rest. A tube may be placed through the nose down into the stomach to remove fluids and help with the nausea and vomiting. Pain killers are given to relieve the pain.

When the pancreatitis is caused by a gallstone, it can be removed by an endoscopic procedure called ERCP. This technique involves passing a thin flexible tube called an endoscope through the mouth into the small intestine where the pancreas empties its digestive enzymes. Most people feel better within a few days, after which time liquid can be started and low-fat, solid food can be added.

Patients with chronic pancreatitis may need frequent pain medications, especially if alcohol intake is not stopped. Because the pancreas is permanently damaged, there may be a need for enzyme replacement to compensate for the lack of digestive enzymes. In severe cases there may be a need for insulin injections to control blood sugar. In very severe cases, surgery may be required.

• Pancreatitis is a condition that occurs when the pancreas becomes inflamed. The pancreas produces digestive enzymes needed to break down food and makes insulin which is needed to control blood sugar. When the pancreas is inflamed it releases its own enzymes causing damage to the pancreas and surrounding structures.
• The incidence of pancreatitis has been increasing worldwide. (Greenberg et al. 2016)
• The peak incidence of pancreatitis is between 40 and 70 years of age. (Teshima et al. 2012)
• In 2016, there were 116,500 new cases of pancreatitis in Canada, representing a 75% increase in its incidence since 1990. (Institute for Health Metrics and Evaluation 2018)
• In 2016, there were 474 deaths and over 1,600 years lost to disability due to pancreatitis in Canada. (Institute for Health Metrics and Evaluation 2018)
• Based on extrapolation of US data, pancreatitis incurs direct annual healthcare costs of about $200 million in Canada. (Canadian Digestive Health Foundation 2009)

_{Citations:
Canadian Digestive Health Foundation. 2009. Establishing digestive health as a priority for Canadians. The Canadian Digestive Health Foundation – National Digestive Disorders Prevalence & Impact Study Report.
Greenberg JA et al. Clinical practice guideline: management of acute pancreatitis. Can J Surg. 2016 Apr; 59(2):128-40.
Institute for Health Metrics and Evaluation. 2018. Global Burden Disease 2016. https://vizhub.healthdata.org/gbd-compare/ [accessed 3 September 2018]
Teshima CW et al. Canadian Digestive Health Foundation Public Impact Series 5: Pancreatitis in Canada. Incidence, prevalence, and direct and indirect economic impact. Can J Gastroenterol. 2012 Aug;26(8):544-5.}

If I have pancreatitis, am I at risk of developing diabetes?

Chronic pancreatitis can damage the insulin-producing cells of the pancreas, diabetes may develop. If you have a family history of diabetes, you may be more likely to develop the disease. If this happens, you will need insulin or other medicines to keep blood glucose at normal levels.

What is the appropriate diet for someone who has pancreatitis?

The majority of pancreatitis is due to alcohol or gallstones. There are less common causes which require appropriate investigations by a specialist. Avoiding alcohol is extremely important for anyone with pancreatitis.

• Avoid alcohol
• Eat low fat meals – but keep a well balanced diet
• Drink plenty of non-caffeinated fluids to keep well hydrated

Additional recommendations regarding diet and lifestyle include:

• Eating well balanced meals at least 3 per day
• Being sure to adhere to a high fibre diet
• Including calcium in your diet
• Choosing meals low in saturated fats
• Aiming for a healthy weight (BMI 20-25). Note: rapid changes in weight (increase or decrease) can cause stone formation so be sure to make modifications in your weight gradually.