Though pancreatitis and pancreatic cancer are two distinct conditions, chronic inflammation of the pancreas can increase a person's risk of developing pancreatic cancer. With Pancreatic Cancer Awareness Month approaching in November, we turned to Kristie Stinchcomb, NP, Gastroenterology, for a refresher on how pancreatitis develops, progresses and what treatment options are available to manage the condition.
What is pancreatitis?
Pancreatitis is inflammation of the pancreas, an abdominal organ that produces digestive enzymes and secretes hormones such as insulin.
A normal pancreas produces digestive enzymes when food enters the stomach and only activates them once they reach the intestine. In pancreatitis, this safeguard fails, and digestive enzymes are prematurely activated inside the cells. This early release causes the pancreas to begin to digest its own tissues.
What are the most common causes of pancreatitis? Are there certain risk factors that make someone more likely to develop it?
The two most common causes of pancreatitis are gallstones and alcohol use. Gallstones can block the flow of pancreatic enzymes into the intestines. Years of sustained heavy alcohol intake can also cause premature enzyme activation in the pancreas.
Other pancreatitis triggers include:
- High triglycerides
- Certain medications
- Genetics
- Infections
- Tumor
- High calcium
- Inflammation post endoscopic retrograde cholangiopancreatography (ERCP)
What symptoms should people watch for, and what does pancreatitis pain typically feel like?
Symptoms of pancreatitis most notably include an abrupt onset of upper abdominal pain often described as severe, stabbing and continuous in nature. For some, the pain radiates into the back and is aggravated by eating, drinking or lying flat. Alongside pain, bloating, nausea, vomiting or fevers may also occur.
Serious complications can develop within hours to days. Seek medical attention if experiencing abdominal pain that is sudden and severe, accompanied by:
- Unyielding nausea
- Persistent vomiting
- High fevers
- Inability to pass gas
- A hard abdomen
- Confusion
- Low blood pressure
- Yellow skin or eyes (jaundice)
What are the differences between acute and chronic pancreatitis?
Acute pancreatitis is a sudden inflammatory condition that can vary from mild and self-limiting to severe. With appropriate medical treatment, the pancreas can return to its normal function once the inflammation subsides.
Chronic pancreatitis is a progressive inflammatory process in which repeated or ongoing injury to the pancreas causes irreversible scarring, appearing as atrophy on imaging and loss of function.
How is pancreatitis diagnosed? What tests or imaging might a patient undergo?
Acute pancreatitis is diagnosed through laboratory tests and imaging, such as an initial CT scan, possibly followed by an MRI or ultrasound to rule out gallstones and biliary dilation, along with a physical exam. To diagnose acute pancreatitis, at least two of the following three features must be present:
1) Abdominal pain
2) Lipase levels that are three times the upper limit of normal
3) Imaging findings consistent with pancreatitis
In chronic pancreatitis, blood enzymes are typically normal because progressive fibrosis reduces enzyme production in the gland. Therefore, the primary diagnostic methods are imaging, past medical history and possible endoscopic ultrasound (EUS).
How is pancreatitis treated?
Acute pancreatitis is treated with early intravenous fluids, pain control, and early nutrition. Identifying and treating the underlying cause helps prevent recurrence.
Chronic pancreatitis is addressed with pain control, complete alcohol and smoking cessation, and nutritional optimization. Doctors may also prescribe pancreatic enzymes with meals to help the body absorb necessary nutrients. If pancreatitis symptoms do not improve with conservative therapies and lifestyle adjustment, endoscopic or surgical intervention may be considered.
Can pancreatitis cause other health complications?
Pancreatitis can affect the kidneys, lungs, and even the heart. If left untreated, it can lead to multiorgan damage or even death.
Other serious complications of pancreatitis may include:
- Fluid collections that persist after four weeks
- Infection of necrotic tissue around the pancreas
- Blood clots in the veins leading to the spleen, liver or intestines
- Bile duct obstruction
- Pancreatic ascites (fluid buildup)
- Lack of blood flow to the intestines
Final thoughts
It's important to understand that pancreatitis is more than a "stomachache." It can become an extremely painful and serious illness affecting the whole body. Even acute pancreatitis can become life-threatening.
For the majority of people, this condition is preventable. The most significant lifestyle drivers of pancreatitis are heavy alcohol use and cigarette smoking, followed by obesity and untreated high triglycerides. Addressing these modifiable risk factors, stopping drinking and smoking, eating low-fat meals and staying well hydrated, can substantially lower the likelihood of developing pancreatitis and improve overall health.
