Pancreatitis is an inflammation of the?pancreas, a gland that sits behind the stomach and near the first section of the small intestine, the duodenum.
The?pancreas?has two main, essential functions in the body:
- It secretes digestive enzymes to help the intestines digest food.
- It helps regulate blood sugar levels by producing the hormones?insulin?and glucagon.
Pancreatitis occurs when the pancreas's enzymes start digesting pancreatic tissues.?This can cause swelling, bleeding, and damage to the pancreas.?Gallstones,?alcoholism, and certain kinds of medication can cause?pancreatitis.
There are two main types of pancreatitis: acute and?chronic. "Pancreatitis" is often used synonymously with "acute pancreatitis," because this form of the disease — which appears suddenly and is short lived — is the most common. (In this series, the term pancreatitis will refer to acute pancreatitis.)
Signs and Symptoms of Pancreatitis
Within the pancreas, cells called acinar?cells produce proenzymes, which are inactive substances that turn into enzymes through metabolic processes.
These proenzymes travel to the small intestine via the pancreatic duct, where they are converted into active forms. Once active, the enzymes get to work digesting carbohydrates, proteins, fats, and other food substances.
But if the acinar cells become damaged or the pancreatic duct is injured or blocked, the proenzymes may accumulate within the pancreas and activate prematurely.
When this happens, the enzymes digest cell membranes in the pancreas, sparking an inflammatory response from the immune system.
Symptoms differ for acute and chronic pancreatitis.
Acute Pancreatitis Symptoms
- A sharp, sudden pain in the abdomen that you may also feel in your back, which is a defining symptom of acute pancreatitis
- Elevated heart rate
- Swollen abdomen
People with acute pancreatitis usually don't look or feel well; it's important to seek medical treatment right away, notes the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (1)
Acute pancreatitis comes on suddenly and usually subsides within a week with treatment, although severe cases can last longer. It’s most often caused by gallstones or excessive alcohol consumption, but certain drugs or elevated triglycerides (a form of fat found in the blood) can bring on an attack.
Chronic Pancreatitis Symptoms
Chronic pancreatitis is most commonly the result of alcoholism. Individuals with chronic pancreatitis often have had several bouts of acute pancreatitis. The pain in the abdomen that accompanies acute pancreatitis — which radiates in your back and may worsen after eating — can still be present, but not as strong. Sometimes, though, there's no pain at all.
Causes and Risk Factors of Pancreatitis
The most common causes of acute?pancreatitis are?gallstones?and alcohol.
Gallstones are?pebble-like deposits that form in the?gallbladder?as a result of the hardening of two substances:?cholesterol?and bilirubin. Bilirubin?is a?byproduct?of the breaking down of red blood cells that is found in bile. (This substance also contributes to jaundice.)
Research indicates that gallstones cause 40 to 70 percent of acute?pancreatitis cases, according to UpToDate. (2) Small gallstones — usually less than 5 millimeters — increase the risk of pancreatitis, per past research. (3)
It's thought that gallstones cause pancreatitis?by creating an obstruction in the pancreatic?duct. This forces digestive enzymes back into the pancreas, which leads to inflammation.
Another common cause of acute pancreatitis — in about 30 percent of cases — is excessive alcohol consumption, notes the Merck Manual. (4)
It's unclear just how alcohol causes the condition, but it's thought that the way the pancreas processes alcohol may generate compounds that are toxic to the organ's?acinar cells.
Alcohol may also sensitize acinar cells to the effect of cholecystokinin, a?hormone?secreted by the duodenum that stimulates the release of digestive enzymes.
It's hard to pin down just how many drinks will lead to acute pancreatitis. One study, which followed Swedish men and women for several years and was published in the?British Journal of Surgery, found that the risk of acute pancreatitis?increased 52 percent with every increment of five drinks consumed on one occasion. (5)
It's worth keeping in mind that the?National Institute on Alcohol Abuse and Alcoholism?defines binge drinking as four drinks in about two hours for women, and five drinks in about two hours for men. (6)?The?Substance Abuse and Mental Health Services Administration?defines heavy drinking?as binge drinking for five or more days in one month. (7, PDF)
What Are Other Causes of Pancreatitis?
Medical students use the mnemonic?"I GET SMASHED"?to remember the following additional causes of pancreatitis:
- I for idiopathic (unknown causes)
- G for gallstones
- E for ethanol (alcohol)
- T for trauma
- S for?steroids
- M for mumps — as well as other infections, such as ascaris lumbricoides parasites, Coxsackie B virus,viral hepatitis, leptospirosis, and?HIV?— and?malignancy (tumors)
- Autoimmune pancreatitis, which develops from an excess of IgG4 antibodies
- S for scorpion stings
- H for hyperlipidemia and?hypertriglyceridemia (elevated levels of fat in your blood) and?hypercalcaemia (elevated blood calcium levels, which may cause calcium to deposit in the pancreatic duct or mediate the activation of pancreatic enzymes)
- E for ERCP, or endoscopic retrograde cholangiopancreatography, an invasive diagnostic technique
- D for drugs
Which Drugs Cause Pancreatitis?
Drugs cause pancreatitis?in various ways. They may, for example,?be toxic to the pancreas, constrict the pancreatic duct, cause vascular problems, or affect the pancreatic processing systems.
Drug-induced pancreatitis?is rare. It's estimated that medication is only responsible for 1.4 to 2 percent of cases, per an article published in 2015 in the Oschner Journal. (8)?But there are many different drugs that can cause it.
According to an article published in the journal?Baylor University Medical Center Proceedings,?there are?published case reports of drug-induced pancreatitis for more than 40 of the top 200 most prescribed drugs. (9)
The report notes the six most common drugs or drug classes associated with pancreatitis:
- Statins, which lower cholesterol and includes Zocor (imvastatin)?and?Lipitor (atorvastatin)
- ACE inhibitors, which include?Vasotec (enalapril)?and?Zestril (lisinopril), for hypertension and?congestive heart failure
- Estrogens in?oral contraception?and hormone replacement therapy
- Diuretics, including?Lasix (furosemide)?and?Microzide (hydrochlorothiazide)
- Highly active antiretroviral therapy (HAART), including?Epivir (lamivudine)?and?Viracept (nelfinavir)?for HIV
- Valproic acid (Depakote, Depacon, Stavzor)?for seizures
How Is Pancreatitis Diagnosed?
You'll have a physical examination, and your doctor will order?blood tests and imaging tests to confirm whether you have either acute or severe?pancreatitis. During the physical examination, your doctor may feel your stomach to see whether your muscles are rigid or your stomach is tender.
The blood test, which can only point to pancreatitis — not diagnose it for certain — measures the amount of two digestive enzymes in the pancreas.
With the onset of acute pancreatitis, the levels of those enzymes are higher than usual —?typically more than 3 times the normal level, per Stat Pearls. (10) Other blood tests may measure kidney function and white blood cell count.
Your doctor may also order the following imaging tests to check for the presence of gallstones, inflammation, and other changes:
- Computerized tomography (CT) scans
- Endoscopic?ultrasounds (EUS)
- Magnetic resonance?cholangiopancreatography?(MRCP)
The EUS?test involves inserting a lighted tube into your mouth and down into your intestine to check for blockage or damage.
The MRCP?is a form of MRI?in which you are injected with a dye that illuminates the pancreas and surrounding areas.
Chronic pancreatitis?is diagnosed in the same way. The doctor may order different blood tests, because in chronic pancreatitis,?the digestive enzyme levels may appear normal. Stool tests are also common, because chronic pancreatitis?compromises the organ's ability to digest and absorb nutrients, which creates changes in stool, per Medline Plus. (11)
Duration of Pancreatitis
For some people, acute pancreatitis may require an extended (a week or more) hospital stay after causing issues such as dehydration,?low blood pressure, and possibly organ failure. These symptoms typically subside within a few days.
Chronic pancreatitis does improve or go away, but only worsens over time, leading to permanent damage, notes Medline Plus. (12)
Treatment and Medication Options for Pancreatitis
Acute pancreatitis that is mild can be treated with rest and pain medication taken at home. You may have to follow a low-fat, no-alcohol pancreatitis diet, as high-fat foods and alcohol can irritate the pancreas and cause pain. Other recommended lifestyle changes could include quitting smoking and losing weight.
Depending on how severe the case is, it may require a hospital stay, where you’ll receive intravenous (IV) fluids, and possibly insulin if your blood sugar or triglyceride levels are high. If a secondary infection is discovered, you’ll be prescribed?antibiotics. If gallstones are determined to be the cause, you may have to have your gallbladder removed.
In both acute and chronic pancreatitis, surgery may be needed if there is dead or infected pancreatic tissue. In chronic pancreatitis, you may also need to take medicines and vitamins due to the impaired absorption of nutrients.
Prevention of Pancreatitis
Making certain lifestyle modifications can help reduce your risk for pancreatitis. This includes:
Limiting Alcohol Consumption This might even mean cutting it out entirely. The most common cause of acute pancreatitis is excessive alcohol consumption, and chronic pancreatitis most commonly is due to alcoholism.
Eating a Low-Fat Diet?Avoiding fatty and fried foods can reduce your risk for gallstones, a leading cause of acute pancreatitis. High levels of triglycerides can also increase your risk for acute pancreatitis. Limiting foods high in simple sugars (sweets, sugary sodas) can help.
Exercising Regularly?Being overweight increases your risk of gallstones, which puts you at greater risk for pancreatitis. But avoid crash-diets, which can cause your liver to increase cholesterol production, which in turn increases your risk for gallstones.
Not Smoking?Adults who smoked were 1.5 times more likely to develop acute or chronic pancreatitis than nonsmokers, according to review of studies published in September 2019 in journal?Pancreatology. (13)
Complications of Pancreatitis
Roughly 15 percent of acute pancreatitis cases are severe, notes the National Pancreas Foundation. (14)?In severe pancreatitis, the enzymes eating away at the organ cause pancreatic necrosis, or death of pancreatic tissue. But pancreatic necrosis is not fatal on its own.
Severe pancreatitis can also cause organ failure, gastrointestinal bleeding, and possibly death.
Because of the long-term damage sustained by the pancreas, chronic pancreatitis may result in?diabetes?due to impaired insulin secretion, as well as difficulty digesting and absorbing the nutrients needed to keep your body running as it should.
Chronic pancreatitis can also lead to exocrine pancreatic insufficiency, in which the pancreas is so damaged that it lacks the digestive enzymes to properly digest fats, proteins, and carbohydrates; this can lead to malnutrition and weight loss.
This can also lead to osteoporosis (bone loss) in people with chronic pancreatitis. Research published in June 2016 in PLoS One also suggested that people with acute pancreatitis — especially women over 50 — have a greater risk for developing osteoporosis. (16)
Research and Statistics: Who Gets Pancreatitis?
Pancreatitis is the cause of more than 500,000 hospitalizations each year in the United States,?according to the NIDDK. (17)
An article published in November 15 in the?journal Pancreas noted that each year there are an estimated 5 to 73 cases of acute pancreatitis per every 100,000 people worldwide. (18)
Pancreatitis is rare in children, though the number of children with acute pancreatitis has increased. (15)
Acute pancreatitis affects men and women equally, but men are more at risk for developing chronic pancreatitis.
Chronic pancreatitis results in about 86,000 hospital stays per year. (15)
BIPOC and Pancreatitis
Black Americans and Pancreatitis
The risk of pancreatitis is two- to threefold higher among Black Americans than white Americans, noted a study in the journal Gastroenterology. (19) The reasons for this are not clear and researchers say more studies are urgently needed.
A study published in October 2016 in The American Journal of Gastroenterology found that when compared with white patients, Black patients were almost twice as likely to be diagnosed with chronic pancreatitis due to alcohol or smoking. (20) They were also more likely to have "constant or severe" pain and have more disease-related disability.
Indigenous People and Pancreatitis
A review of studies and meta-analysis published in January 2019 in Digestive Diseases and Sciences noted that the incidence of acute pancreatitis was 4.8-fold higher among an indigenous population (New Zealand Maori) compared with white study subjects.?(21) The incidence of post-pancreatic diabetes mellitus was up to 3 times higher in indigenous populations.
Resources We Love
Pancreatitis can be a difficult condition to navigate, but there are a lot of resources out there that can provide more information on the illness, as well as places to find support.?Click below for a comprehensive resources guide.
Additional reporting by Carlene Bauer.
Editorial Sources and Fact-Checking
- Symptoms and Causes of Pancreatitis. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). November 2017.
- Etiology of Acute Pancreatitis. UpToDate.com. January 9, 2019.
- Diehl?AK,?Holleman?DR Jr, Chapman JB, et al. Gallstone Size and Risk of?Pancreatitis.?Archives of Internal Medicine. August 1997.
- Bartle M. Acute Pancreatitis. Merck Manual. July 2019.
- Sadr-Azodi?O,?Orsini?N,?Andrén-Sandberg??,?Wolk?A. Effect of Type of Alcoholic Beverage in Causing Acute?Pancreatitis.?British Journal of Surgery. November 2011.
- Drinking Levels Defined.?National Institute on Alcohol Abuse and Alcoholism.
- Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. August 2019.
- Jones M, Hall OM, Kaye AM, Kaye AD. Drug-Induced Acute?Pancreatitis: A Review.?The?Oschner?Journal. Spring 2015.
- Kaurich?T. Drug-Induced Acute?Pancreatitis.?Baylor University Medical Center Proceedings. January 2008.
- Acute Pancreatitis. StatPearls. June 23, 2020.
- Stool Elastase. MedlinePlus. February 26, 2020.
- MedlinePlus. March 17, 2016.
- Tobacco Smoking and the Risk of Pancreatitis: A Systematic Review and Meta-Analysis of Prospective Studies. Pancreatology. December 2019.
- Acute Pancreatitis Risks and Treatment. National Pancreas Foundation.
- Definition and Facts for Pancreatitis. National Institute of Diabetes and Digestive and Kidney Diseases. November 2017.
- Lin S, Hsu W, Lin CC, et al. Effect of Acute Pancreatitis on the Risk of Developing Osteoporosis: A Nationwide Cohort Study. PLoS One. June 2017.
- Digestive Diseases Statistics for the United States. National Institute of Diabetes and Digestive and Kidney Diseases. November 2014.
- Afghani E., Pandol SJ, Shimosegawa T, et al. Acute Pancreatitis — Progress and Challenges. Pancreas. November 2015.
- Yadav D, Lowenfels A. The Epidemiology of Pancreatitis and Pancreatic Cancer. Gastroenterology. June 2013.
- Wilcox C, Sandhu B, Singh V, et al. Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis. The American Journal of Gastroenterology. October 2016.
- Cervantes A, Waymouth EK, Petrov MSl. African-Americans and Indigenous Peoples Have Increased Burden of Diseases of the Exocrine Pancreas: A Systematic Review and Meta-Analysis.?Digestive Diseases and Sciences. January 2019.