Acute Pancreatitis: What You Should Know?>

Acute Pancreatitis: What You Should Know

by Tim Gower

Acute pancreatitis sends 275,000 Americans to the hospital each year, and the incidence of this painful and potentially deadly condition appears to be rising in older men and women. It’s not clear why acute pancreatitis is on the rise, but it may have to do with the population’s increasing age and the steady rise in type 2 diabetes, which is a risk factor for pancreatitis.

What’s more, recent studies suggest that the condition is often more severe among older adults, particularly the elderly, which makes prompt treatment critical.

Pancreatitis basics

Pancreatitis is inflammation of the pancreas, a gland that’s about six inches long and resides behind your stomach. The pancreas makes digestive enzymes that flow through the pancreatic duct to the small intestine. These enzymes, along with bile from the gallbladder, break down many of the foods we eat for use as energy by the body. The pancreas also makes insulin and glucagon, hormones that help regulate blood glucose (sugar) levels.

A bout of acute pancreatitis almost always requires a hospital stay to replenish fluids and rest the pancreas. Many cases are mild and subside within about a week. But complications can develop, especially in moderate to severe cases. You can become dehydrated and your blood pressure may drop, which can damage organs close to the pancreas and adversely affect functioning of more distant organs, such as the heart, lungs, and kidneys.

Other complications include a collection of fluid near the pancreas (pseudocyst), an infection or an abscess, and bleeding in the pancreas. Some of these complications can lead to shock and even death. Acute pancreatitis is fatal in about one in 20 patients.

Symptoms of pancreatitis

The hallmark symptom of acute pancreatitis is severe pain in the upper abdomen, often on the right side, which sometimes radiates to the mid-back, and may be relieved by leaning forward. The pain might first occur after meals, especially after eating fatty foods. Eventually, the pain may become constant.

Other symptoms of acute pancreatitis include:

  • Nausea and vomiting
  • Shortness of breath
  • Fever
  • Abdominal bloating
  • Jaundice

In older adults, stomach pain may be less intense than in younger persons. Pain may also appear later in the course of the condition.

What causes pancreatitis?

The two most common causes of acute pancreatitis are gallstones and alcohol consumption, usually in excess, accounting for up to three-quarters of all cases:

  • Gallstones. These small, pebblelike masses can travel from the gallbladder and down the common bile duct and obstruct the drainage of the pancreas. Gallstones are the most common cause of acute pancreatitis among older adults.
  • Heavy alcohol use. A long history of moderate to heavy drinking causes one-quarter to one-third of all acute pancreatitis attacks. The mechanism as to why this occurs is not clear, but genetic factors and the way alcohol is metabolized likely play a role. Cigarette smoking increases the risk of alcohol-inducedpancreatitis.

Less commonly, acute pancreatitis can be triggered by certain medications, high levels of triglycerides (usually above 1,000 mg/dL), trauma or injury to the pancreas, a duodenal ulcer that pushes into the pancreas and causes inflammation, or a complication from a procedure called endoscopic retrograde cholangiopancreatography (ECRP), which is used to diagnose and treat diseases of the pancreatic and bile ducts. A family history of pancreatitis can also be a factor.

Drugs That Can Cause Pancreatitis

Certain medications may spark acute pancreatitis within weeks or months of starting them. Here are some examples of common offenders.

In rare cases, pancreatic cancer could be causing pancreatitis, especially in patients who are over 40 or have a family history of pancreatic cancer. A Swedish study in 2018 in the American Journal of Gastroenterology found that 70 percent of 769 patients with pancreatic cancer had a previous episode of acute pancreatitis. Cancer risk was highest within two months of pancreatitis and faded over time, leading the researchers to suggest that acute pancreatitis may on occasion be an early symptom ofpancreatic cancer.

It’s important for doctors to try to identify the underlying cause of pancreatitis to prevent its return. However, no cause can be found in about 20 percent of cases.

Why age matters

Older adults who develop pancreatitis have more severe bouts of the condition and an increased risk of death compared to younger individuals, according to several recent studies. One likely reason is that older people often have coexisting medical conditions that may be exacerbated by pancreatitis or make them more susceptible to complications. And because older adults don’t always have the classic intense abdominal pain or they have symptoms that are less obvious and tend to overlap with those of other conditions, a diagnosis might be delayed.

Chronic vs. Acute Pancreatitis

If injury to the pancreas is long term, such as when a patient persists in drinking alcohol heavily, a chronic form of pancreatitis may develop, bringing severe pain and possibly leading to type 2 diabetes.

A study in the April 2019 issue of the Scandinavian Journal of Gastroenterology,which looked at people with acute pancreatitis in one Swedish hospital, found that those older than 65 required longer hospital stays and were significantly more likely to end up in the intensive care unit than younger individuals. Roughly 7 percent of older people with severe acute pancreatitis died, compared to about 2 percent of their younger counterparts.

Another study, in the December 2018 issue of Clinical Interventions in Aging, found that men and women 80 and older admitted to surgical wards in Poland for acute pancreatitis were more than twice as likely as younger patients to have severe acute pancreatitis and were five times morelikely to die.

Treating acute pancreatitis

If you develop acute pancreatitis, you’ll be closely monitored in the hospital and given fluids intravenously. You’ll also be offered medication to relieve any abdominal pain. If pain, nausea, and vomiting prevent you from eating for a few days, you may need a feeding tube. If you have gallstones, you may need ECRP to remove the gallstones or surgery to remove your gallbladder to prevent a recurrence. You may need to have collections of fluid drained or a course of antibiotics to treat infectious complications.

You’ll also need to stop drinking alcohol and follow a nutritious, low-fat diet. Your doctor will address other factors that may have led to your pancreatitis to prevent future recurrences, such as treatinghigh triglycerides.

This article first appeared in UC Berkeley Health After 50.

Also see Alcohol's Deadly Toll.