Protect Yourself From Pancreatitis

If you’ve been experiencing nagging abdominal pain that worsens after eating, you could have pancreatitis (inflammation of the pancreas). The condition occurs in acute and chronic forms, and both can cause complications—in fact, acute pancreatitis is one of the most common reasons for hospitalization due to gastrointestinal issues in the United States.

What Causes Pancreatitis?

You likely know that the pancreas produces insulin, the hormone that regulates blood sugar levels. But it also produces enzymes that aid in digestion. “These enzymes are inactive within the pancreas,” says Brijen J. Shah, MD, associate professor of gastroenterology at Mount Sinai. “Ordinarily, they don’t become active until they have traveled through the pancreatic duct to the small intestine. But if pancreatic enzymes are activated when they are still in the pancreas, they attack pancreatic tissue, causing irritation and inflammation.”

Acute Pancreatitis

This is usually caused by gallstones, or excessive alcohol consumption. The pancreatic duct joins the common bile duct coming from the gallbladder where they both empty into the small intestine (see image, above right). If a gallstone—tiny stones that can form in the gallbladder—becomes lodged in the common bile duct, it can obstruct the pancreatic duct. “This results in a build-up of enzymes within the pancreas, and, eventually, the enzymes will attempt to ‘digest’ the pancreas,” Dr. Shah explains.

Gallstones are more common in older adults, and this is likely the reason why acute pancreatitis is more likely than the chronic form to affect this age group. “Older adults also are more likely to take drugs that can contribute to pancreatitis,” Dr. Shah adds. These include corticosteroids (anti-inflammatory drugs), and thiazide diuretics (see our p5 article for more on these).

Where alcohol is concerned, the link with pancreatitis is not fully understood. “However, alcohol may directly injure pancreatic cells and also cause tiny protein deposits to build up and form plugs that block the pancreatic duct,” says Dr. Shah. Other potential causes of acute pancreatitis include smoking, and elevated triglycerides (fats that circulate in the blood).

Symptoms of acute pancreatitis include pain in the upper abdomen that comes on gradually or suddenly, and lasts for a few days. The pain may radiate to the back, and sometimes gets worse after eating. Other symptoms include nausea and vomiting, fever, and rapid pulse. “In severe cases, the heart, lungs, or kidneys may be affected,” Dr. Shah notes, “but it is important to keep in mind that these more severe complications are rare—about 85 percent of acute pancreatitis cases are categorized as mild.”

Chronic Pancreatitis

In chronic pancreatitis, the inflammation persists instead of resolving. Chronic pancreatitis is most commonly caused by years of alcohol abuse—there also is evidence of an association with smoking. “Some people also have a hereditary form of chronic pancreatitis that begins in childhood but isn’t detected until many years later,” Dr. Shah adds.

As with acute pancreatitis, the main red flag for chronic pancreatitis is pain in the abdomen. The pain can be intermittent but is often constant. Nausea, vomiting, weight loss, and greasy or oily stools also can occur. “Weight loss is another sign, and occurs because the digestive enzymes your body relies on to break down food and absorb nutrients are not reaching the small intestine,” Dr. Shah explains. “In severe cases, chronic pancreatitis may reduce the amount of insulin the pancreas produces, raising the risk of diabetes.”

Pancreatitis Treatment

Acute pancreatitis treatment involves a period of fasting (usually a few days) so the pancreas can rest. “You may need to spend time in the hospital being fed intravenously for a short time if the inflammation persists,” Dr. Shah says. “If alcohol is contributing to your condition, you will need to stop drinking. If the cause is gallstones, your doctor may advise gallbladder removal.”

If you have chronic pancreatitis, medications are used to relieve the pain. “A special diet that is high in carbohydrates and low in fat may be required, and your doctor also may prescribe pancreatic enzymes to help you properly digest food and regain any lost weight,” Dr. Shah says. “If chronic pancreatitis has impaired your insulin production, you may need to take drugs to help control your blood sugar levels. In some cases, surgery is required to drain fluid from the pancreas, or remove part of the organ.”

If your pancreatitis is linked to alcoholism, or you’re a heavy smoker, continuing these habits may result in serious complications. “It’s important for everyone to limit their alcohol intake and stop smoking, but for patients with pancreatitis this is critical,” Dr. Shah emphasizes. Both habits can be difficult to quit, but support can make a big difference—see What You Can Do for information on where you can get advice and counseling.

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