What Is the Pancreas?
The pancreas is an organ/gland that is adjacent to the small intestine and behind the stomach. The pancreas has two major functions:
- Producing and releasing digestive enzymes in the small intestine to help in the digestion process
- Releasing glucagon and insulin into the bloodstream to help the body use energy properly
What Is Pancreatitis?
According to the US National Library of Medicine, pancreatitis occurs when the pancreas becomes swollen. Damage to the pancreas as a result of pancreatitis or some other issue occurs when digestive enzymes that are normally released by the pancreas are activated before they are released into the small intestine. There are two forms of pancreatitis.
- Acute pancreatitis is inflammation of the pancreas that only lasts for very short periods of time and then resolves. Its severity may range from life-threatening to mild. The majority of cases of acute pancreatitis result in complete recovery, but in severe cases, there can be tissue damage, infection, and even the formation of cysts.
- Chronic pancreatitis is long-lasting inflammation of the pancreas that continues after acute pancreatitis. There are various potential causes of chronic pancreatitis, including chronic alcohol use.
Symptoms of Pancreatitis
According to the book Pancreatitis and Its Complications, there are specific symptoms of pancreatitis. The symptoms of acute pancreatitis most often include a swollen or tender abdomen, abdominal pain that radiates to the back (often exacerbated by eating fatty foods), nausea, vomiting, increased heart rate, and fever. Symptoms of chronic pancreatitis include the above symptoms as well as weight loss, diarrhea, and even diabetes.
Causes of Pancreatitis
According to the book Pancreatic Diseases – Advances in Research and Treatment, the major causes of pancreatitis include:
- Reactions to medications
- Infections or autoimmune diseases
- Complications of surgery
- Hereditary issues
- Metabolic issues
- Heavy alcohol use
Risk Factors for Pancreatitis
Chronic pancreatitis as a result of long-term alcohol use and abuse is identified in nearly 70 percent of the cases, whereas about 20 percent of cases of chronic pancreatitis have no discernible cause and may result from numerous interacting issues. The risk factors for chronic pancreatitis include hereditary factors, the development of gallstones, an infection or complication of surgery, and heavy alcohol use. Other conditions, such as lupus or high levels of triglycerides, may increase the risk for chronic pancreatitis.
Anyone may develop chronic pancreatitis, especially if they use alcohol heavily on a regular basis, but it appears that males between the ages of 30 and 40 are the largest demographic group diagnosed with the disorder.
Does Alcohol Cause Pancreatitis?
Although not fully understood how alcohol causes the pancreas to become inflamed, studies have shown a clear link between alcohol use and acute pancreatitis. Acute pancreatitis caused by drinking too much alcohol makes up 17%-25% of the world’s cases and is the second most common cause after gallstones. This is usually manifested due to individuals drinking consistently over a five-year period with around 4-5 drinks daily (binge drinking). It is important to note that acute pancreatitis rarely is the result of isolated binge drinking.
Chronic pancreatitis is often the result of chronic alcohol consumption, resulting in around 40% to 70% of all cases. Those already struggling with acute pancreatitis who are also chronic alcohol abusers, may experience recurrent bouts leading to chronic pancreatitis.
Further, alcohol-induced pancreatitis occurs in patients who have prolonged, chronic alcohol use. Symptoms include constant epigastric pain which may also radiate to the mid-back or flanks as well as nausea or vomiting.
To treat alcohol-induced pancreatitis, patients are encouraged to stop drinking alcohol while following the treatment protocol for other causes of pancreatitis. While there are no clear indications for what type of diet works for each person, treatment may also involve following a low-fat diet and starting a clear liquid diet with slow progression to solid meals. Further, professional treatment of alcohol abuse and alcoholism may be recommended to decrease alcohol use, minimize hospital admissions for recurrent attacks, and to prevent development of chronic pancreatitis.
What Tests Are Done to Diagnose Pancreatitis?
According to the book Pancreatitis: Medical and Surgical Management, the diagnosis of pancreatitis involves the use of:
- Analysis of digestive enzymes in the blood (amylase and lipase), as high levels of these enzymes suggest acute pancreatitis (along with the symptoms reported above)
- Tolerance tests that measure damage to the pancreas
- Pancreatic function tests that determine if the pancreas is creating enzymes in the correct amounts
- Imaging tests, such as an ultrasound, a CT scan, or an MRI, to help physicians look at the pancreas and determine if there is any damage.
- Urine tests to determine the presence of any bile or enzymes that may indicate pancreatitis
- Stool tests
These tests, in addition with the patient’s presentation, are used to determine the diagnosis of either acute or chronic pancreatitis.
How to Treat Pancreatitis
Acute pancreatitis may be treated with medications (particularly analgesics or other pain medications) and fluids. In some cases (e.g., chronic gallstones), surgical removal of the gallbladder may be required. Once the diseased gallbladder is removed, inflammation of the pancreas will typically resolve. In some cases of severe pancreatitis, surgery may be required to remove damaged tissue from the pancreas.
Treatment for chronic pancreatitis may involve medications to control pain, nutrition therapy, and the administration of insulin or other enzymes. In some cases, a low-fat diet may be useful. Surgery may also be necessary in some cases.
Individuals who drink alcohol in large amounts are advised to stop, and sometimes, this can assist in the treatment of chronic pancreatitis. Prevention is the best cure for chronic pancreatitis for most individuals.
According to the Cleveland Clinic, chronic pancreatitis results in more than 56,000 hospitalizations per year and more than 122,000 outpatient visits. Some of the complications associated with the diagnosis of chronic pancreatitis include:
- Pseudocysts, which are fibrous and fluid-filled substances that appear to be cysts and produce significant pain and vomiting
- Biliary obstruction, which is an obstruction of the bile duct that can result in jaundice (bile in the bloodstream)
- Obstructions in the gastrointestinal tract, which can be very painful and produce significant nausea and vomiting
- Fluid around the pancreas (pancreatic ascites) that may also be the result of pseudocysts
- The increased potential to develop pancreatic cancer (pancreatic adenocarcinoma)
Treating Pancreatitis and Alcohol Addiction
Individuals who develop chronic pancreatitis as a result of long-term alcohol abuse most likely have a moderate to severe alcohol use disorder. These individuals typically cannot stop drinking alcohol without some form of professional intervention or very strong participation in peer support groups, such as Alcoholics Anonymous (AA). Very often, treating physicians will recommend that an individual with chronic pancreatitis get involved in a formal alcohol use disorder recovery program that includes a medical detox component (a physician-assisted withdrawal management program), participate in intensive alcohol use disorder therapy (group therapy, individual therapy, or both), participation in groups like AA, and take periodic or random alcohol screenings to ensure continued abstinence from alcohol.
Individuals who develop chronic pancreatitis from alcohol abuse will often experience severe pain and discomfort associated with any use of alcohol at all. In individuals who have moderate to severe alcohol use disorders, even the experience of pain and vomiting as a result of drinking alcohol may not be enough to discourage them from continued alcohol use. Thus, these individuals often require long-term commitment to an alcohol use disorder treatment program in order to abstain from alcohol.
If the cause of acute pancreatitis can be found and treated, the prognosis is typically good. Factors that can affect the prognosis for people diagnosed with chronic pancreatitis are continued use of alcohol (the most salient factor that can result in significant complications associated with chronic pancreatitis), the person’s age when the diagnosis of pancreatitis is made (with older individuals having a poorer prognosis), tobacco use, and the presence of any liver disease, particularly cirrhosis.
It appears that the overall survival rate for individuals with chronic pancreatitis at 10 years following diagnosis is around 70 percent, and around 45 percent at 20 years following diagnosis, making the mortality rate 30 percent at 10 years following diagnosis and 55 percent at 20 years following diagnosis. The risk of developing pancreatic cancer appears relatively low, approximately 4 percent at 20 years after diagnosis. However, these figures are radically increased if the individual continues to use alcohol.