The pancreas plays a key role in all aspects of maintaining a healthy digestive system.
Men especially need to make sure they are looking after the pancreas, which plays an essential role in converting the food we eat into fuel for the body’s cells.
An organ that is tucked behind the stomach in the upper abdomen, the pancreas has two main functions: it makes enzymes, which help digest proteins, fats and carbohydrates before they can be absorbed in the intestine; and it makes hormones (chemicals made from glands), the most important of which is insulin, which control how the body processes sugar (glucose), its main source of energy.
Chronic pancreatitis (CP) is an inflammation of the pancreas that does not heal or improve.
It gets worse over time and leads to permanent damage, eventually impairing the person’s ability to digest food and make pancreatic hormones.
CP often develops in patients between the ages of 30 and 40 and is more common in men than women.
Alcohol is the predominant cause of CP in the western world and is particularly prevalent in South Africa.
Acute pancreatitis is sudden inflammation of the pancreas that may be mild or life-threatening, but usually subsides.
“Alcohol abuse or gallstones that pass into the bile duct are the most common causes of acute pancreatitis,” said Prof Jose Ramos, head of HPB Surgery at Wits University Donald Gordon Medical Centre.
“The pancreas may be damaged by prolonged heavy drinking or by intermittent binge drinking.
“Alcohol is also the most common cause of chronic pancreatitis and accounts for over 70 per cent of cases in South Africa.
“The risk of pancreatitis from gallstones is relatively low.
“However, due to the high prevalence of gallstone disease, this is one of the most common causes of pancreatitis, particularly in communities where alcohol consumption is low,” Ramos explained.
He added that there are also many other causes of acute pancreatitis, including drug reactions, high triglyceride levels in the blood, high calcium levels in the blood, viral infections and autoimmune disease.
In many instances, the cause of the pancreatitis is unknown and is referred to as idiopathic pancreatitis.
Acute pancreatitis can also be the first symptom of an underlying pancreatic tumour.
“When a patient presents with symptoms that are suggestive of pancreatitis, it is very important for the patient to be seen by a healthcare practitioner and for the proper blood investigations to be performed as soon as possible after the onset of the symptoms,” said Ramos.
“Acute pancreatitis typically results in very high levels of amylase and lipase in the blood, making confirmation of the diagnosis relatively simple.
“These elevated blood levels, however, may return to normal within two to four days of the onset of pain and later testing will not be able to confirm the diagnosis of pancreatitis.
“An abdominal ultrasound or CAT scan can also be used to aid in the diagnosis of this disease,” said Ramos.
Causes of chronic pancreatitis
• Heavy alcohol use.
• Autoimmune conditions (when the body’s immune system attacks the body).
• Genetic mutations due to cystic fibrosis.
• Blocked pancreatic duct or common bile duct.
• Familial pancreatitis (runs in the family, when two or more immediate family members have a history of pancreatitis).
Symptoms of chronic pancreatitis
• Most people experience pain in the upper abdomen, although some have no pain at all.
• The pain may spread to the back, become worse with eating or drinking and become constant and disabling.
• In some cases, the abdominal pain goes away as the condition worsens, but this is fairly uncommon.
• Nausea.
• Vomiting.
• Weight loss.
• Diarrhoea.
• Oily or fatty stools.
• Clay-coloured or pale stools.
CP may lead to a decreased quality of life due to pain, and often requires admission to hospital for the treatment of symptoms.
How to prevent chronic pancreatitis
• Limit alcohol consumption. By drinking less or not at all, you can help protect your pancreas from the toxic effects of alcohol and reduce your risk for pancreatitis.
• Eat a low-fat diet. Gallstones, a leading cause of acute pancreatitis, can develop when too much cholesterol accumulates in your bile, the substance made by your liver to help digest fats. To reduce your risk for gallstones, eat a low-fat diet that includes whole grains and a variety of fresh fruits and vegetables.
• Exercise regularly and lose excess weight. People who are overweight are more likely to develop gallstones, putting them at greater risk for acute pancreatitis.
• Skip crash diets. The caveat to losing weight is to do it gradually. When you go into crash-diet mode, prompting quick weight loss, your liver ramps up cholesterol production in response, which increases your risk for gallstones.
• Don’t smoke. Studies show that smoking cigarettes is linked to acute pancreatitis.
“As chronic pancreatitis is most commonly related to prolonged alcohol abuse, the easiest way to prevent this disease is to avoid abusing alcohol,” said Ramos.
“Less common causes of chronic pancreatitis include autoimmune disease and genetic disorders resulting in familial pancreatitis which cannot be prevented.
“The consequences of the disease can, however, be treated with medications and, if necessary, endoscopic or surgical interventions.”
Treatment options
Individuals with chronic pancreatitis frequently lose weight, even when their appetite and eating habits are normal. The weight loss occurs because the body does not secrete enough pancreatic enzymes to digest food, a condition known as pancreatic exocrine insufficiency (PEI), so nutrients are not absorbed normally, leading to malnutrition.
In patients suffering from PEI, pancreatic enzyme replacement therapy (PERT) facilitates the digestion and subsequently the absorption of fats, proteins, and carbohydrates.
Standard treatment for PEI due to CP is an individualised dosage of pancreatic enzyme supplementation according to the degree of maldigestion and the fat content of the diet.
Along with medical treatment, other complementary pancreatitis therapies that can help patients feel better include yoga, massage therapy, therapeutic massage, physical exercise, meditation, laughter and acupuncture.
“Fortunately, the majority of cases of acute pancreatitis are mild and resolve with minimal supportive treatment,” said Ramos.
“In a small percentage, the disease is life-threatening with serious acute, short-term and medium-term consequences.”
Those patients who survive the acute attack generally make a full recovery, but in alcohol-related pancreatitis, the damage to the pancreas has already occurred before the first onset of pancreatitis and progresses with further attacks as well as ongoing alcohol abuse.
Once the symptoms of chronic pancreatitis are present, it is usually irreversible and results in marked reduction in the pancreatic function.
“Diabetes and pancreatic exocrine insufficiency due to lack of hormones and pancreas enzymes can fortunately be fairly well treated with replacement therapy.
“The majority of patients with chronic pancreatitis, however, develop severe, chronic and disabling pain, which is very difficult to treat, and quality of life is severely impacted.
“It is, therefore, imperative to intervene in patients at risk for chronic pancreatitis before that stage is reached.
“Cessation of alcohol intake and smoking is vital to avoid end-stage pancreatic disease.”
If you think you may be at risk, speak to your doctor or pharmacist for more information and how to make appropriate lifestyle changes.
