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Pancreatitis

Also listed as: Pancreas - inflammation of

Signs and Symptoms
What Causes It?
Who's Most At Risk?
What to Expect at Your Provider's Office
 
Treatment Options
Prognosis/Possible Complications
Following Up
Supporting Research

Pancreatitis is inflammation of the pancreas, an organ that produces several enzymes to aid in the digestion of food, as well as the hormone insulin, which controls the level of sugar (glucose) in the blood. The pancreas is located in the upper abdomen, behind the stomach. When the pancreas is inflamed, the body is not able to absorb all the nutrients it needs.

Pancreatitis may be either acute (sudden and severe) or chronic. Both types of pancreatitis can cause bleeding and tissue death in or around the pancreas. Mild attacks of acute pancreatitis can get better on their own, or with dietary changes. In the case of recurring pancreatitis, however, long term damage to the pancreas is common, sometimes leading to malnutrition and diabetes.

Necrotizing pancreatitis (in which pancreatic tissue dies) can lead to cyst like pockets and abscesses. Because of the location of the pancreas, inflammation spreads easily. In severe cases, fluid containing toxins and enzymes leaks from the pancreas through the abdomen. This can damage blood vessels and lead to internal bleeding, which may be life threatening.

Signs and Symptoms

Common signs and symptoms of pancreatitis include the following:

  • Mild to severe, ongoing, sharp pain in the upper abdomen that may radiate to back or chest
  • Nausea and vomiting
  • Fever
  • Sweating
  • Abdominal tenderness
  • Rapid heart rate
  • Rapid breathing
  • Oily stools (chronic pancreatitis)
  • Weight loss

What Causes It?

There are several possible causes of pancreatitis. The most common are gallstones, which block the duct of the pancreas (for acute pancreatitis), and excessive alcohol consumption (for chronic pancreatitis).

  • Certain drugs, including azathioprine, sulfonamides, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics such as tetracycline
  • Infection with mumps, hepatitis virus, rubella, Epstein-Barr virus (the cause of mononucleosis), and cytomegalovirus
  • Abnormalities in the structure of the pancreas or the pancreatic or bile ducts, including pancreatic cancer
  • High levels of triglycerides (fats) in the blood
  • Surgery to the abdomen, heart, or lungs that temporarily cuts off blood supply to the pancreas, damaging tissue
  • Hereditary diseases, such as cystic fibrosis
  • Injury to the abdomen
  • Gallstones
  • Chronic alcohol abuse

Who's Most At Risk?

People with these conditions or characteristics have a higher risk for pancreatitis:

  • Biliary tract disease
  • Binge alcohol use and chronic alcoholism
  • Recent surgery
  • Family history of high triglycerides
  • Age (most common ages 35 - 64)
  • Smokers

African-Americans are at higher risk than Caucasians and Native Americans.

What to Expect at Your Provider's Office

Your health care provider will examine you for signs and symptoms of pancreatitis. Your health care provider may also perform blood tests, take x-rays, and use ultrasound, computed tomography (CT) scans, and other procedures to determine the severity of your condition and decide which treatment options are most appropriate. In the case of chronic pancreatitis, your doctor may test your stool for excess fat (which your body, lacking the enzymes produced by the pancreas, is not able to absorb) and may order pancreatic function tests to check whether your pancreas can secrete the necessary enzymes.

Treatment Options

Treatment Plan

Acute pancreatitis may require hospitalization, where you will receive medication for pain. You will also fast, to allow the pancreas to rest and stabilize. You will receive intravenous fluids and nutrition (parenteral nutrition). If you have gallstones, your doctor may recommend surgery or other procedures to remove them.

People with chronic pancreatitis may require treatment for alcohol addiction, if that is the cause. Treatment also includes pain management, enzyme supplements, and dietary changes. Treatment for patients who have pancreatitis due to high triglyceride levels includes weight loss, exercise, eating a low fat diet, controlling blood sugar (if you have diabetes), and avoiding alcohol and medications that can raise triglycerides, such as thiazide diuretics and beta-blockers.

Drug Therapies

You may be given painkillers. Antibiotics may be given to treat or prevent infection in some cases. Enzyme supplements, such as pancrelipase (Lipram, Pancrease, Viokase), may be prescribed to help your body absorb food better.

Surgical and Other Procedures

Different types of surgical procedures may be necessary, depending on the cause of the pancreatitis. With infected pancreatic necrosis (tissue death), surgery is virtually always required to remove damaged and infected tissue. Surgery may also be required to drain an abscess. For chronic pancreatitis with pain that won't respond to treatment, a section of the pancreas may need to be removed. If the pancreatitis is a result of gallstones, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) may be necessary. In ERCP, a specialist inserts a tube like instrument through the mouth and down into the duodenum to access the pancreatic and biliary ducts.

Complementary and Alternative Therapies

It is important to get conventional medical treatment for pancreatitis as soon as possible. A severe attack can be life threatening if left untreated. Most alternative therapies have not yet been studied for use specifically in pancreatitis, although some evidence indicates that antioxidants may have beneficial effects. Several therapies, though, may reduce the risk of developing pancreatitis or ease some of the symptoms when used in conjunction with conventional care. You should never treat pancreatitis without your doctor's supervision.

Numerous studies have explored the role of oxidative stress in pancreatitis. Oxidative stress results from the production of free radicals, which are byproducts of metabolism that are harmful to cells in the body. Antioxidants help rid the body of harmful free radicals. Low antioxidant levels in the blood (including reduced amounts of vitamins A, C, and E, selenium, and carotenoids) may lead to chronic pancreatitis due to the destructive effects of increased free radicals. Antioxidant deficiency and the risk of developing pancreatitis may be particularly linked in areas of the world with low dietary intake of antioxidants. In addition, the cooking and processing of foods may destroy antioxidants. Alcohol induced pancreatitis is linked to low levels of antioxidants as well. There is also some evidence that antioxidant supplements may eliminate or minimize oxidative stress and help alleviate pain from chronic pancreatitis.

Nutrition and Supplements

People who are susceptible to pancreatitis should avoid alcohol consumption.

Some evidence suggests that increasing your intake of antioxidants (found in fruits and green vegetables) may help protect against pancreatitis or alleviate symptoms of the condition. Several studies have explored the role of free radicals, which are byproducts of metabolism that are harmful to cells in the body, in pancreatitis. Antioxidants are often recommended to help rid the body of free radicals, and low levels of antioxidants in the blood may make someone more likely to develop pancreatitis. Alcohol induced pancreatitis is linked to low levels of antioxidants as well.

Following these nutritional tips may help reduce risks and symptoms:

  • Eliminate all suspected food allergens, including dairy (milk, cheese, eggs, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
  • Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy) or beans for protein.
  • Use healthy oils for cooking, such as olive oil or vegetable oil.
  • Reduce significantly or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, and donuts. Also avoid French fries, onion rings, processed foods, and margarine.
  • Avoid coffee and other stimulants, alcohol, and tobacco.
  • Drink 6 - 8 glasses of filtered water daily.
  • Exercise moderately for 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

  • A multivitamin daily, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tablespoonfuls oil daily, to help decrease inflammation and improve immunity. Omega-3 fatty acids can have a blood thinning effect and may increase the effect of blood thinning medications, such as Coumadin (warfarin) and aspirin.
  • Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity. Coenzyme Q-10 might help the blood clot. By helping the blood clot, coenzyme Q-10 might decrease the effectiveness of warfarin (Coumadin).
  • Vitamin C, 1 - 6 gm daily, as an antioxidant. Vitamin C may interfere with vitamin B12, so take doses at least 2 hours apart. Lower the dose if diarrhea develops.
  • Probiotic supplement (containing Lactobacillus acidophilus and other beneficial bacteria), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration.
  • Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
  • Resveratrol (from red wine), 50 - 200 mg daily, for antioxidant effects.

Herbs

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer). Although herbs should never be used alone to treat pancreatitis, some herbs may be helpful along with conventional medical treatment. Tell your physician about any herb or CAM therapy you may be considering. Many herbs can interfere with certain medications; speak with your physician.

  • Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily. Use caffeine free products. You may also prepare teas from the leaf of this herb. Green tea has powerful antioxidant properties.
  • Holy basil (Ocimum sanctum) standardized extract, 400 mg daily, for antioxidant protection. Holy basil can have a blood thinning effect and may increase the effect of blood thinning medications, such as Coumadin (warfarin) and aspirin.
  • Rhodiola (Rhodiola rosea) standardized extract, 150 - 300 mg 1 - 3 times daily, for immune support. Rhodiola is an "adaptogen" and helps the body adapt to various stresses.
  • Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation and immune stimulation. Cat's claw can interact with many medications and can have deleterious effects on patients with leukemia and Parkinson's disease.
  • Reishi mushroom (Ganoderma lucidum), 150 - 300 mg 2 - 3 times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day. High doses of Reishi can have a blood thinning effect and may increase the effect of blood thinning medications, such as Coumadin (warfarin) and aspirin.
  • Indian gooseberry (Emblica officinalis) powder, 3 - 6 grams daily in favorite beverage for antioxidant support. Emblica is a traditional Ayurvedic medicinal plant used to treat pancreatic disorders. It is a powerful antioxidant and one of the richest natural sources of vitamin C. Animal studies suggest that this herb can be used to prevent pancreatitis.
  • Grape seed extract (Vinis vinifera) standardized extract, 100 - 300 mg daily for antioxidant support. Grape seed extract can have a blood thinning effect and may increase the effect of blood thinning medications, such as Coumadin (warfarin) and aspirin, as well as other drug interactions; speak with your doctor.

Individual case reports suggest that Traditional Chinese Medicine (TCM) can be effective for preventing and treating pancreatitis. To determine the right regimen, consult a skilled herbalist or licensed and certified practitioner of TCM, and keep all of your health care providers informed of any supplements, herbs, and medications you are taking.

You may be given:

  • Licorice root (Glycyrrhiza glabra)
  • Ginger root (Zingiber officinale)
  • Asian ginseng (Panax ginseng)
  • Peony root (Paeonia officinalis)
  • Cinnamon Chinese bark (Cinnamomum verum)

Acupuncture

Studies evaluating acupuncture as a treatment for pancreatitis show mixed results. Some case reports say that acupuncture helped relieve pain from pancreatitis and pancreatic cancer. But a review of several studies finds mixed evidence that acupuncture and electroacupuncture (small electrical currents applied through acupuncture needles) are effective for pancreatitis.

Prognosis/Possible Complications

Possible complications of pancreatitis include:

  • Infection of the pancreas
  • Cyst like pockets that can become infected, bleed, or rupture
  • The failure of several organs (heart, kidney, lungs) and shock due to toxins in the blood
  • Type II diabetes

In mild cases of pancreatitis, where only the pancreas is inflamed, the prognosis is excellent. In chronic pancreatitis, recurring attacks tend to become more severe.

Following Up

Patients with chronic pancreatitis should eat a low-fat diet, abstain from alcohol, and avoid abdominal trauma to prevent acute attacks and further damage. About 70% if pancreatitis cases are considered to be induced by alcohol -- and half of those who had alcohol-induced acute pancreatitis will have relapses. Continued drinking is a dose-responsive risk factor for relapse. Those with high triglyceride levels should lose weight, exercise, and avoid medications, such as thiazide diuretics and beta-blockers, that increase triglyceride levels. Given reports suggesting that oxidative stress may contribute to the development of pancreatitis, and that antioxidant supplementation may be of some benefit, health care providers may begin recommending antioxidant nutrients to their patients with pancreatitis.

Supporting Research

Bhat KPL, Kosmeder JW 2nd, Pezzuto JM. Biological effects of resveratrol. Antioxid Redox Signal. 2001;3(6):1041-64.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Diehl DL. Acupuncture for gastrointestinal and hepatobiliary disorders. J Altern Complement Med. 1999;5(1):27-45.

Feldman: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed. Philadelphia, PA: Elsevier Inc., 2010.

Greer S, Burchard K. Acute Pancreatitis and Critical Illness. Chest. 2009;136(5).

McClave SA, Chang WK, Dhaliwal R, et al. Nutrition support in acute pancreatitis: a systematic review of the literature. JPEN J Parenter Enteral Nutr. 2006 Mar-Apr;30(2):143-56.

Morris-Stiff GJ, Bowrey DJ, Oleesky D, Davies M, Clark GW, Puntis MC. The antioxidant profiles of patients with recurrent acute and chronic pancreatitis. Am J Gastroenterol. 1999;94(8):2135-2140.

Morris-Stiff G, Webster P, Frost B, Lewis WG, Puntis MC, Roberts SA. Endoscopic ultrasound reliably identifies chronic pancreatitis when other imaging modalities have been non-diagnostic. JOP. 2009;10(3):280-3.

Motoo Y, Su SB, Xie MJ, Taga H, Sawabu N. Effect of herbal medicine Saiko-keishi-to (TJ-10) on rat spontaneous chronic pancreatitis. Int J Pancreatol. 2000;27(2):123-129.

Pearce CB, Sadek SA, Walters AM, Goggin PM, Somers SS, Toh SK, Johns T, Duncan HD. A double-blind, randomised, controlled trial to study the effects of an enteral feed supplemented with glutamine, arginine, and omega-3 fatty acid in predicted acute severe pancreatitis. JOP. 2006 Jul 10;7(4):361-71.

Pelli H, Sand J, Nordback I. Can the recurrence of alcohol induced pancreatitis be prevented? Duodecim. 2009;125(11):1195-200.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

Shi J, Yu J, Pohorly JE, Kakuda Y. Polyphenolics in grape seeds-biochemistry and functionality. J MedFood. 2003;6(4):291-9.

Schulz HU, Niederau C, Klonowski-Stumpe H, Halangk W, Luthen R, Lippert H. Oxidative stress in acute pancreatitis. Hepatogastroenterology. 1999;46(29):2736-2750.

Scolapio JS, Malhi-Chowla N, Ukleja A. Nutrition supplementation in patients with acute and chronic pancreatitis. Gastroenterol Clin North Am. 1999;28(3):695-707.

Shachar E, Scapa E. Drug induced pancreatitis. Harefuah. 2009;148(2):98-100.

Shapiro H, Singer P, Halpern Z, Bruck R. Polyphenols in the treatment of inflammatory bowel disease and acute pancreatitis: the missing ingredient in enteral and parenteral nutrition formulas? Gut. 2006 Aug 24;Epub ahead of print.

Thorat SP, Rege NN, Naik AS, et al. Emblica officinalis: a novel therapy for acute pancreatitis -- an experimental study. HPB Surg. 1995;9(1):25-30.

Tolstrup JS, Kristiansen L, Becker U, Gronbaek M. Smoking and risk of acute and chronic pancreatitis among women and men: a population-based cohort study. Arch Intern Med. 2009;169(6):603-9.

Uden S, Bilton D, Nathan L, et al. Antioxidant therapy for recurrent pancreatitis: a placebo-controlled trial. Aliment Pharmacol Ther. 1990;4:357-371.


Review Date: 12/6/2010
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network (10/13/2010).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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