Pancreatitis

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. Interestingly, risk of acute pancreatitis has been linked with the amount of spirits consumed on a single occasion, but not with wine or beer consumption.

Who is 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 to 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 provider may also perform blood tests, take x-rays, and use ultrasound, computed tomography (CT) scans, and other diagnostic tests 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

Your doctor may prescribe painkillers. You may also receive antibiotics to treat or prevent infection in some cases. Your doctor may also prescribe enzyme supplements, such as pancrelipase (Lipram, Pancrease, Viokase), to help your body absorb food. In some cases, doctors may prescribe steroids to treat autoimmune pancreatitis.

Surgical and Other Procedures

Different types of surgical procedures may be necessary depending on the cause of the pancreatitis. People who have pancreatic necrosis (tissue death) almost always require surgery to remove damaged and infected tissue. Surgery may also be required to drain an abscess. For chronic pancreatitis with pain that will not respond to treatment, doctors may need to remove a section of the pancreas. 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 antioxidants to help rid the body of harmful cells called 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. Health care providers may recommend increasing your intake of antioxidants to help rid the body of free radicals. 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-rich 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 coconut 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 to 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 to 2 capsules or 1 to 2 tbsp. of oil daily, to help reduce 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 warfarin (Coumadin) and aspirin.
• Coenzyme Q10 (CoQ10), 100 to 200 mg at bedtime, for antioxidant and immune activity. CoQ10 might help the blood clot. By helping the blood clot, CoQ10 might decrease the effectiveness of warfarin (Coumadin).
• Vitamin C, 1 to 6 mg 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 to 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements require refrigeration. Check the label. Some clinicians will not give probiotics to severely immune-compromised patients. Speak with your physician.
• Alpha-lipoic acid, 25 to 50 mg twice daily, for antioxidant support. Taking alpha-lipoic acid in the presence of a Thiamine (vitamin B1) deficiency can cause serious health issues. Alpha-lipoic acid may also interact with certain chemotherapy drugs.

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 to 2 heaping tsp/cup water steeped for 10 to 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 complementary therapy you may be considering. Many herbs can interfere with certain medications. Speak with your physician.

• Green tea (Camellia sinensis) standardized extract, 250 to 500 mg daily. Use caffeine-free products. You may also prepare teas from the leaf of this herb. Green tea has powerful antioxidant properties. Green tea can potentially worsen anemia and glaucoma.
• 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 warfarin(Coumadin) and aspirin.
• Rhodiola (Rhodiola rosea) standardized extract, 150 to 300 mg, 1 to 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 disease. As an immune stimulant, there is some concern that cat's claw may worsen autoimmune disease.
• Reishi mushroom (Ganoderma lucidum), 150 to 300 mg, 2 to 3 times daily, for inflammation and immunity. You may also take a tincture of this mushroom extract, 30 to 60 drops, 2 to 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 warfarin (Coumadin) and aspirin. Reishi may lower blood pressure, so you should use extra caution if you take blood pressure medication.
• Indian gooseberry (Emblica officinalis) powder, 3 to 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. Indian gooseberry may increase the risk of bleeding, especially among people who take blood-thinning medications. Speak with your doctor.
• Grape seed extract (Vinis vinifera) standardized extract, 100 to 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 warfarin (Coumadin) 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)

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 was inconclusive.

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. Overall, 10-year survival approximates 70%, and 20-year survival is about 45%. Death is not usually due to pancreatitis itself, but rather to malignancy, postoperative complications, and complications of alcohol or tobacco.

Following Up

People 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% of 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 antioxidants to people with pancreatitis.

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