Pancreatitis

Pancreatitis is a condition where the pancreas is damaged by enzymes that are normally inactive. This can lead to pain, digestive problems, and severe complications.
As mentioned earlier, there are two forms of pancreatitis:

The frequency of pancreatitis has increased in recent years, particularly among younger people. In Switzerland and other European countries, the incidence of acute pancreatitis ranges between 5 and 24 per 100,000 inhabitants per year. These differences are attributed to various diagnostic criteria and regional variations.

Although exact figures for Switzerland are difficult to determine, studies show that men are more likely to develop chronic pancreatitis than women. In about 80% of cases of chronic pancreatitis, excessive alcohol consumption is the main cause. In Switzerland, gallstones and alcohol excess account for approximately 90% of acute pancreatitis cases.

The age of those affected varies depending on the form of the disease. In hereditary pancreatitis, the first symptoms can appear in early childhood. The acute form commonly affects adults, with age over 55 being considered a risk factor.

Particularly concerning is the increase in disease frequency among young people who consume nicotine and alcohol. Besides these factors, gallstones, abdominal injuries, infections, or genetic predisposition can also contribute to the development of pancreatitis.

Approximately 15% of patients with acute pancreatitis suffer from the most severe form of inflammation, often requiring intensive care treatment. This underscores the importance of early detection and prevention of this disease in Switzerland.

Acute pancreatitis is characterized by the sudden onset of inflammation, which can be triggered by various factors. It leads to severe upper abdominal pain, nausea, and vomiting, and in severe cases can lead to complications such as tissue damage or organ failure. With early treatment, acute pancreatitis often heals completely, but can be life-threatening in severe cases.

The symptoms of acute pancreatitis often appear suddenly and can be very severe. They occur due to inflammation of the pancreas, which prematurely activates digestive enzymes and damages surrounding tissue.

The abdominal pain is intense and occurs in the upper abdomen. It often has a belt-like pattern. The pain can radiate to the sides or back, which is typical for pancreatic involvement. The pain often worsens after eating or when lying down.

Typical symptoms include severe, belt-like radiating pain in the upper abdomen, accompanied by nausea and vomiting. This can be very distressing. They occur due to irritation and disrupted function of the digestive system and pancreas. Since food intake can worsen pain and nausea, many affected individuals develop an aversion to eating.

Fever occurs as a sign of systemic inflammation. This is triggered by damage to the pancreatic tissue. The temperature increase signals that the body is trying to fight the inflammation. In severe cases, fever can also indicate an infection or complication such as necrosis.

Affected individuals often suffer from sweating due to pain, circulatory stress, and fever. Additionally, sweating occurs as a side effect of the body’s general stress response.

Yellowing of the skin, mucous membranes, and whites of the eyes due to the accumulation of bilirubin in the body. Due to bile duct blockages, bilirubin cannot be metabolized as usual through liver processes.

Bloated and distended abdomen and digestive disorders such as flatulence and diarrhea often occur as accompanying symptoms. Due to pancreatic inflammation, function is impaired and fewer digestive enzymes are produced. This leads to incomplete food utilization and gastrointestinal tract problems.

The inflammatory response can lead to low blood pressure and circulatory problems. This is often due to fluid shift into tissues (edema), vasodilation, and loss of fluids through vomiting, sweating, and diarrhea.

In severe cases, circulatory shock can occur, which is a life-threatening consequence.

The causes and risk factors are diverse and often traced back to sudden irritation or blockage of the pancreas. The most common triggers include gallstones, which obstruct the flow of digestive juices, and excessive alcohol consumption. Medications, infections, or injuries can also trigger inflammation of the pancreas.

When gallstones are present, a stone may break loose from the gallbladder and migrate into the bile ducts. This can lead to a bile duct blockage. Since the bile ducts and pancreatic ducts merge before entering the duodenum, this can cause a backup of pancreatic juice. This backup can activate normally inactive enzymes, leading to inflammation.

The clinical guidelines by Beyer et al. (2022) on acute and chronic pancreatitis show that alcohol consumption or gallstones are the cause of inflammation in 30 to 50% of cases. The risk of the disease increases with increasing alcohol consumption. While the exact mechanism of how alcohol leads to acute pancreatitis has not been fully understood, there are various theories regarding this.

Very high blood lipid levels can lead to the formation of harmful fatty acids that attack pancreatic cells. Simultaneously, the blood becomes thicker, impeding pancreatic blood flow and damaging cells. This activates pancreatic digestive enzymes, which begin to destroy the tissue itself and further worsen the inflammation.

Several medications can lead to pancreatitis (ACE inhibitors, azathioprine, furosemide, 6-mercaptopurine, pentamidine, diabetes medications, sulfonamides, and valproate).

Infectious diseases such as mumps, Coxsackie B virus, Hepatitis A and E, and cytomegalovirus can cause acute pancreatitis by directly damaging pancreatic tissue or triggering an inflammatory immune response.

When the pancreas is injured (e.g., through operations or accidents), the sensitive tissue is damaged, leading to the activation of digestive enzymes that attack the pancreas.

After surgery, various problems can trigger acute pancreatic inflammation. These include injuries to the pancreas or bile ducts during the procedure, reduced blood flow due to low blood pressure, or abdominal infections. Medications or gallstones blocking the ducts after surgery can also irritate the pancreas and cause inflammation.

Certain congenital malformations can irritate the pancreas and trigger acute inflammation. For example, the pancreas may not fuse properly (pancreas divisum) or form a ring around the duodenum (annular pancreas), which obstructs the flow of digestive juices. Abnormal connections between pancreatic and bile ducts can also cause problems. Such malformations are rare but can be treated surgically in some cases.

The consequences of pancreatitis range from mild symptoms such as pseudocysts, which can heal on their own, to life-threatening complications like organ failure or severe infections.

If left untreated, pancreatic inflammation can cause serious complications such as necrotizing pancreatitis or organ failure.

Following pancreatic inflammation, fluid, digestive enzymes, tissue debris, and inflammatory substances can accumulate near the gland, forming what’s known as a pancreatic pseudocyst. Sometimes they rupture or become infected, which can be dangerous.

In severe inflammations, part of the pancreatic tissue dies – this is called necrosis. This dead tissue can no longer function and becomes an ideal breeding ground for bacteria. If infection occurs, treatment becomes difficult and can lead to serious complications such as abscesses or sepsis (blood poisoning).

Due to inflammation, the pancreas becomes more susceptible to infections from intestinal bacteria. When bacteria enter the pancreas, the situation can deteriorate rapidly. An infected pancreas can cause abscesses (pus collections) or sepsis (blood poisoning), which is life-threatening and often requires surgical treatment or drainage.

In severe pancreatitis, inflammatory substances can spread throughout the body and affect other organs such as the lungs, kidneys, and cardiovascular system. This is a very serious complication requiring intensive care treatment.

The diagnosis of pancreatitis is made through a combination of blood tests, which check the levels of enzymes like lipase and amylase, along with various imaging procedures.

No single blood test can definitively confirm acute pancreatitis, but certain tests provide indicators. The enzymes amylase and lipase, produced by the pancreas, usually rise on the first day of acute pancreatitis and normalize after 3 to 7 days. In recurring episodes, the increase may be less pronounced due to tissue destruction and reduced enzyme production.

Treatment of acute pancreatitis typically occurs in the hospital, often with intensive monitoring to control vital functions such as circulation and breathing. Pain is managed through targeted pain therapy, and fasting helps relieve stress on the pancreas, often supplemented by nutritional infusions. The underlying cause, such as gallstones, is treated either through endoscopic procedures or surgery. In severe cases or complications, such as infections or organ failure, therapy is adjusted accordingly, including antibiotics or intensive care management.

Chronic pancreatitis is a persistent inflammation of the pancreas that leads to permanent damage and scarring in the tissue. It typically develops through years of alcohol consumption or, in rare cases, through genetic mutations, resulting in reduced production of digestive enzymes and insulin by the organ. Those affected suffer from recurring abdominal pain, digestive disorders, and may develop diabetes in the long term.

The symptoms of chronic pancreatitis often develop gradually and can persist for years. They develop due to progressive damage to the pancreas, which affects both digestion and metabolism. The most common complaints include recurring abdominal pain, digestive problems, and signs of enzyme or hormone deficiency, such as weight loss or diabetes.

Persistent or recurring pain in the upper abdomen that may radiate to the back in a belt-like pattern. Often occurs after eating and can last for hours or even days.

The inflammation leads to reduced production of digestive enzymes, preventing the body from properly breaking down nutrients such as fats, proteins, and carbohydrates. This results in bloating, diarrhea, and fatty stools (steatorrhea).

Inflammation and pain often lead to reduced appetite. Nausea and vomiting may also occur, especially after fatty meals.

Due to digestive problems, the body absorbs fewer nutrients, leading to unintended weight loss. Additionally, many affected individuals eat less to avoid pain.

The pancreas produces not only digestive enzymes but also insulin. In chronic inflammation, insulin-producing cells can be destroyed, leading to the development of diabetes. Symptomatic signs include increased thirst and frequent urination.

Yellowing of the skin, mucous membranes, and whites of the eyes due to the accumulation of bilirubin in the body. Due to bile duct blockages, bilirubin cannot be metabolized as usual through normal metabolic processes.

The most common cause of chronic pancreatitis is excessive alcohol consumption, followed by smoking and genetic factors. Mechanical blockages of the pancreatic ducts or metabolic disorders can also damage the pancreas and cause persistent inflammation.

Long-term, excessive alcohol consumption is the most common cause of chronic pancreatitis. Alcohol directly damages pancreatic cells and leads to persistent inflammation. It also promotes the formation of pancreatic stones that can block the ducts. In about 80% of cases of chronic pancreatitis, excessive alcohol consumption is the main cause.

Smoking significantly increases the risk of developing chronic pancreatitis. Smoking promotes inflammatory processes in the pancreas and accelerates tissue damage. When combined with alcohol abuse, it has an amplifying effect.

Certain gene mutations such as the PRSS-1 mutation, which leads to digestive enzyme dysfunction, or the CFTR mutation, which can lead to cystic fibrosis. In cystic fibrosis, viscous secretions accumulate in the pancreatic ducts. Autoimmune pancreatitis also falls under genetic mutations, where the body’s immune system attacks the pancreas (autoimmune disease) and can ultimately lead to chronic pancreatitis.

Stones or tumors can lead to impaired drainage of digestive enzymes. This can lead to increased pressure and tissue irritation, subsequently triggering chronic inflammation.

Through elevated blood calcium levels, often due to metabolic disorders, calcium crystals can deposit in the pancreatic ducts and activate pancreatic enzymes prematurely within the pancreas. This can lead to inflammation and destruction of pancreatic tissue.

Chronic inflammation leads to ongoing inflammation, which in turn can cause irreversible damage to the pancreas.

The pancreas produces fewer digestive enzymes. As a result, the body cannot properly break down fats, proteins, and carbohydrates, leading to diarrhea, fatty stools (steatorrhea), bloating, and weight loss.

Chronic inflammation can cause fluid to accumulate in the pancreas, forming so-called pseudocysts. These can bleed, rupture, or become large enough to cause pain or block adjacent structures such as the duodenum or bile ducts.

Over time, the insulin-producing cells of the pancreas are destroyed, gradually leading to diabetes mellitus. This further impairs blood sugar regulation.

People with chronic pancreatitis have an increased risk of developing pancreatic cancer, as chronically inflamed tissue is more susceptible to malignant changes.

The diagnosis of chronic pancreatitis is based on a combination of blood tests that can detect inflammation markers or functional disorders, and imaging procedures such as CT or MRI that visualize structural changes in the pancreas. These methods help identify typical damage such as tissue changes, calcifications, or pseudocysts. Additionally, functional tests can be used to evaluate the enzyme production of the pancreas.

Blood tests are less helpful in cases of chronic pancreatitis compared to acute forms. However, the two enzymes lipase and amylase may be elevated in chronic pancreatitis, provided that scarring has not progressed too far and thus pancreatic function is not severely limited. Glucose levels (blood sugar) are also of interest here, as chronic pancreatitis can lead to diabetes over time.

The prognosis for chronic pancreatitis varies significantly.
Even if alcohol is not the trigger, all persons who suffer from chronic pancreatitis should stop drinking alcohol and smoking.

Both conventional medical and complementary medical approaches and treatment methods are available for treating chronic pancreatitis. Conventional medical therapies typically include medication treatments, dietary modifications, and in some cases, surgical interventions. Complementary medical approaches can be used as supplements and often aim to improve general well-being and support the body’s self-healing powers. Comprehensive treatment ideally considers both approaches to achieve the best possible results for the patient.

The treatment of chronic pancreatitis in conventional medicine aims to alleviate symptoms, prevent complications, and improve patients’ quality of life. Various therapeutic approaches are available that can be individually tailored to the course of the disease.

The therapy includes:

Various complementary medical approaches can be meaningfully integrated to support therapy. These supplementary methods aim to improve overall health, strengthen the immune system, and alleviate possible side effects of the main treatment.

These are just some examples of complementary medical approaches. There are numerous other methods that can be considered depending on the individual situation and in consultation with the treating physician.

Pancreatitis is a serious condition that can occur either acutely or chronically. To help you better understand this disease, we have compiled and answered the most common questions.

The information listed contains relevant topics and serves to improve understanding.