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.
Common signs and symptoms of pancreatitis include the following:
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).
People with these conditions or characteristics have a higher risk for pancreatitis:
African-Americans are at higher risk than Caucasians and Native Americans.
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.
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.
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.
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.
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.
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:
You may address nutritional deficiencies with the following supplements:
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.
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:
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.
Possible complications of pancreatitis include:
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.
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.
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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.
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