The pancreas may not be an organ that you think about often. After all, it is deep in the abdominal cavity, so it is well protected, but also difficult to access. It produces specific hormones like insulin along with enzymes which enable the breakdown of food into very little pieces making the absorption into our body possible.
But when the pancreas becomes inflamed, it can cause pancreatitis. Each year, there are more than 300,000 admissions to the hospital for the treatment of acute pancreatitis with an estimated cost greater than $2 billion.
TYPES OF PANCREATITIS
pancreatitis can present in three different ways.
Acute pancreatitis – a painful and, at times, deadly condition. It can be caused by gallstones and alcohol abuse as well as other less likely conditions such as elevated triglycerides, high calcium blood levels, problems with the thyroid and even as a result of taking certain medications. Ninety percent of patients with acute pancreatitis will have a full recovery in three to four days; but, ten percent of patients may develop severe disease which can result in respiratory, renal, or cardiac complications, some of which can result in a high mortality rate if not addressed immediately.
Recurrent acute pancreatitis – when a patient develops two or more episodes of pancreatitis with a full recovery between attacks. When this happens, it is extremely important to try to find an underlying cause to enable proper treatment and prevent disease progression. This patient population may have underlying genetic mutations that lead to more damage of the pancreas. Over the past ten years, significant progress has been made finding and understanding genetic mutations that lead to pancreatitis, both recurrent, acute and chronic. Approximately a third of patients with recurrent pancreatitis will go on to develop chronic pancreatitis.
Chronic pancreatitis – when a patient has significant pancreatic disease due to persistent exposure to an underlying trigger such as smoking, alcohol, some metabolic disorders and genetic mutations. These patients frequently seek medical help with the main complaint of pain that can be very severe, difficult to treat and debilitating. Diabetes and exocrine pancreatic insufficiency may also be present in chronic pancreatitis. Cessation of the exposure or trigger is extremely important to prevent more episodes from happening.
CAUSES OF PANCREATITIS
In the past, we thought that all patients with recurrent, acute and particularly chronic pancreatitis were alcoholics, but we now know that only a small percentage of alcoholics will go on to develop pancreatitis (under ten percent). We now recognize that there are other causes for pancreatitis including smoking – which is considered a major risk factor – as well as genetics and autoimmune conditions.
Recognizing and eliminating the underlying cause of pancreatitis is essential. Genetic testing is now frequently implemented and coupled with genetic counseling. When genetic mutations are recognized we sometimes offer complete removal of the pancreas with auto transplantation of the insulin producing cells to prevent diabetes. This radical surgery is offered only to patients with debilitating disease.
Also, endoscopic therapy or surgery can be utilized when patients have symptoms and fluid collection, stones or strictures.
Dr. Andres Gelrud is a pancreatic expert with Gastro Health and the Director of The Pancreatic Disease Center at the Miami Cancer Institute, part of the Baptist Health System. He has a strong interest in adult and pediatric patients with pancreatic disorders including pancreatitis, complications of pancreatitis and high risk patients.