Treatment of pancreatitis

Pancreatitis is an acute or chronic inflammation of the pancreas. The pancreas regulates energy metabolism, supports digestion, and produces hormones (such as insulin, glucagon, and others) that regulate blood sugar levels.

Acute pancreatitis is an inflammation of the pancreas characterized by the rapid development of pathological processes and pronounced symptoms. Most often, it is accompanied by a disruption of enzymatic metabolism — the pancreatic juice is not released and begins to "poison" the gland. This leads to necrotic damage of pancreatic cells and tissue dystrophy.

The disease is accompanied by severe pain in the left side, nausea, vomiting, and other symptoms that compel the patient to seek medical help.

Chronic pancreatitis develops as the next stage of acute pancreatitis. It is characterized by alternating periods of exacerbation and remission, during which symptoms subside and the patient feels better. At the same time, healthy pancreatic cells are gradually replaced by connective tissue, which leads to impaired gland function and worsening of the patient's condition.

Specialists conditionally distinguish two stages of chronic pancreatitis. During the first years, it progresses slowly. Symptoms are usually mild, and exacerbations are infrequent. In the second stage, the disease worsens, and its manifestations disturb the patient almost constantly.

Chronic pancreatitis is more common in older individuals. It is associated with poor diet and frequent alcohol consumption.

Excessive alcohol consumption and various liver and biliary tract diseases account for 97% of pancreatitis cases.

Other risk factors that provoke inflammation of the pancreas:

• gastrointestinal disorders;

• abdominal injuries and trauma;

• taking antibiotics and other medications (furosemide, estrogens, etc.);

• hormonal imbalances;

• metabolic disorders;

• parasites;

• cardiovascular diseases;

• genetic predisposition;

• overeating and consumption of unhealthy foods;

• neuro-psychological overexertion, etc.

The symptoms of acute and chronic pancreatitis differ slightly. In both cases, pain is the primary sign, but it may be sharp or dull and spread to different areas.

Symptoms of acute pancreatitis may include:

• sharp and intense pain in the pancreas area (left side);

• pain radiating to the hypochondrium and back;

• worsening of pain after a heavy meal (antispasmodics may be ineffective);

• abdominal bloating;

• fever 1–2 degrees above normal;

• pale skin and mucous membranes of the mouth and throat;

• nausea, vomiting, excessive salivation;

• digestive disorders.

In the early stages, the abdomen may be soft; in later stages, it may become tense. Symptoms of peritonitis or peritoneal irritation may appear. Differential diagnosis is required to determine the condition.

In chronic pancreatitis, the following symptoms may occur:

• pressing, distending pain, typically in the upper abdomen;

• pain radiating to the left shoulder blade, shoulder, and neck;

• rare pain attacks or constant pain;

• impaired digestion;

• worsening of pain after a heavy meal or consumption of hard-to-digest foods (raw vegetables and fruits, fatty and fried foods, sweets, alcohol);

• yellowing of the skin and sclera;

• rapid weight loss.

Diagnosing pancreatitis at early stages is quite difficult. Thorough differential diagnosis is essential, as symptoms of pancreatic inflammation resemble those of cholecystitis, gastric and intestinal ulcers, and other diseases. The required tests and examinations are determined individually by the physician based on symptoms, medical history, and test results.

To diagnose pancreatitis, a patient may be prescribed:

• complete blood count;

• complete urinalysis;

• blood and urine glucose tests;

• blood and urine amylase tests;

• fecal analysis (coprogram) for digestibility and presence of parasites;

• fecal test for pancreatic elastase;

• liver and kidney function tests;

• biochemical blood test (ALT, AST, ALP, total protein, protein fractions);

• lipid profile;

• blood electrolyte test;

• coagulation profile.

To confirm the diagnosis, determine the stage of the disease, and assess the patient’s condition, the following may be assigned:

• gastroscopy – endoscopic examination of the stomach;

• esophagogastroduodenoscopy – endoscopic examination of the stomach and duodenum;

• cholegraphy – X-ray of the bile ducts with contrast;

• duodenography – X-ray of the duodenum with contrast;

• radionuclide cholecystography – X-ray of the gallbladder with radionuclide;

• abdominal ultrasound;

• computed tomography (CT);

• endoscopic retrograde cholangiopancreatography (ERCP) – a combination of endoscopy and X-ray (to detect ductal issues of the pancreas).

Pancreatitis treatment depends on the disease form (acute or chronic), symptom severity, and presence of complications. It can be either medication-based or surgical. In severe cases, hospitalization may be necessary.

Conservative treatment includes antibiotics, antispasmodics, enzyme inhibitors, and other medications as needed. A strict diet is prescribed. Sometimes, eating and drinking may be temporarily prohibited to avoid enzyme production, and intravenous nutrition (IV drips) is administered.

If medication treatment fails or complications develop, surgery may be needed. Surgeons may remove fibrotic tissue or clear pancreatic ducts. One of the surgery's goals is to prevent the pathological process from spreading to other organs.

Chronic pancreatitis treatment at Oxford Medical Clinic is often carried out in a surgical inpatient setting. Doctors prescribe a diet (sometimes fasting for 2–3 days), a special drinking regimen, painkillers, antibiotics, IV infusions, and enzyme inhibitors.

In case of complications, surgical treatments may include abdominal lavage, and in some cases — removal of necrotic pancreatic tissue and gallbladder.

Acute pancreatitis develops over a couple of weeks. If treated promptly, it can be successfully cured within this time. Otherwise, it may become chronic.

Acute and chronic pancreatitis can cause complications such as:

• bile outflow obstruction;

• cysts and pseudocysts;

• pancreatic abscess;

• obstructive jaundice;

• duodenal stenosis;

• cholangitis;

• pancreatic fistula;

• diabetes mellitus;

• internal bleeding;

• peritonitis;

• septic shock;

• kidney and liver failure.

Most complications of pancreatitis are life-threatening and require urgent surgical intervention. To prevent them, it is essential to be regularly monitored and treated by a doctor in case of chronic pancreatitis.

With timely diagnosis and appropriate therapy, pancreatitis is well treatable. Patients can live for years and lead a full life.

The risk of death increases with the development of complications such as exacerbation, infection, and digestive disorders.

About 25% of patients die within 10 years, and up to 50% — within 20 years.

To prevent pancreatitis, it is recommended to maintain a healthy lifestyle and a proper diet. It is also advisable to maintain a normal weight, quit smoking, and avoid frequent alcohol consumption.

Gastroenterologists advise:

• eat in small portions frequently;

• avoid overeating;

• consume food warm, not cold;

• reduce fried, fatty, and spicy foods in the diet;

• limit dairy intake;

• reduce consumption of canned foods, pickles, mayonnaise, coffee, and chocolate;

• avoid fast food and ready-made meals;

• quit smoking and alcohol.

At the first signs of digestive system problems, it is best to consult a gastroenterologist, get examined, and, if necessary, adjust your diet or undergo treatment. This helps reduce the risk of developing pancreatitis and other serious gastrointestinal diseases.