Pancreatitis - inflammation of the pancreas
Inflammation of the pancreas can be acute or chronic. In many cases, existing gallstones or alcohol abuse cause pancreatic disease. In severe cases, the acute form is life-threatening, while chronic pancreatitis can lead to loss of glandular function with indigestion and diabetes. Various treatment options aim to alleviate the symptoms that occur and to prevent complications or to treat them in good time. Affected people should pay close attention to their diet and avoid alcohol and smoking.
Inflammation of the pancreas due to different causes is summarized under the medical term pancreatitis. Inflammation can be acute or chronic. Gallstones and alcohol abuse are the most common triggers.
Pancreatitis occurs relatively rarely, especially in the chronic form, but is a very serious disease of the pancreas. Complications of acute pancreatitis or unsuccessful therapies lead to the death of those affected in about 15 percent of the cases.
In technical jargon, the pancreas is also called the pancreas (from the Greek “meat”). With a length of up to 20 centimeters, it is one of the largest glands in the human body. It is located behind the stomach between the spleen and duodenum.
This organ consists of endocrine and exocrine gland tissue and thus fulfills two vital functions. On the one hand, it produces important digestive juices that are passed on to the intestine, and on the other hand, it forms hormones (insulin and glucagon) to regulate blood sugar levels.
While key symptoms and a number of other complaints are known for the acute form, the chronic variant usually manifests itself with fewer symptoms.
Symptoms of acute pancreatitis
The most important key symptom of acute inflammation of the pancreas is, due to the location of the organ, upper abdominal pain and acute abdominal pain (acute abdomen), which radiate on all sides and, above all, in a belt shape.
This pain is often accompanied by nausea and vomiting, as well as fever. Flatulence (bloated stomach) and signs of intestinal paralysis (paralytic ileus) and an accumulation of fluid in the abdomen can occur. Other accompanying symptoms are possible.
In most cases, the acute inflammation is relatively harmless and there is no permanent damage or damage to other organs (edematous pancreatitis).
However, if the patient shows facial pallor, dizziness and cold sweat, these are the first signs of an impending circulatory shock, which indicates a serious course with complications.
Post-acute, for example, pseudocysts (fluid-filled cavities) as well as abscesses and infections can develop. In about ten percent of cases, a life-threatening condition develops in which tissue completely dies (necrosis) and internal bleeding occurs (necrotizing, hemorrhagic pancreatitis). This serious complication can lead to a so-called SIRS (systematic inflammatory response syndrome) with multi-organ failure.
Symptoms of chronic pancreatitis
The chronic course can run continuously, but is also often shown with relapsing symptoms. The same belt-like upper abdominal pain usually occurs repeatedly as in the acute case of illness. As a rule, the pain lasts for hours to days and can therefore be distinguished from typical colic.
The pain often shows up, as does nausea and vomiting after eating high-fat food (food intolerance). The ingested food can no longer be broken down accordingly (malnutrition and maldigestion) and in many cases there is a weight loss favored by fatty stool and diarrhea.
Digestive disorders are more advanced when a large part of the pancreas is already destroyed. Likewise, about a third of those affected will develop type 1 diabetes due to a lack of insulin. As in the acute case, complications such as pseudocysts and bleeding can adversely affect the course of the disease.
In most cases, the causes can be determined. Rarely (in ten to thirty percent of cases) are idiopathic diseases with no known cause.
Chronic pancreatitis is caused by permanent alcohol abuse in up to eighty percent of cases. In the acute form, alcoholism is the second most common cause with approximately thirty-five percent. This means that the risk of pancreatitis among alcohol-dependent people is around five percent. However, it is not yet known exactly how alcohol is created. In general, there is a connection between the duration and amount of consumption and the occurrence of the disease. (Additional) smoking is also considered a further risk factor.
The most commonly diagnosed cause of acute pancreatitis is gallstones (biliary pancreatitis). The stones can block the place of the common biliary and pancreatic duct (Papilla Vateri) in the transition to the duodenum, which leads to a build-up of bile and pancreatic juice. The enzymes it contains, which are important for digestion, then attack the tissue of the pancreas and there is a self-digesting reaction. The harmful processes on the tissue activate the immune system and there is an inflammatory reaction.
In addition to gallstones (acute) and alcoholism, many other causes can lead to the development of pancreatitis. For example, side effects when taking medication (including azathioprine) and other diseases (e.g. metabolism) can be the reason for the occurrence.
A very rare genetic defect leads to a so-called hereditary pancreatitis. This is a genetic mutation that leads to the destruction of exocrine pancreatic tissue and the appearance of diabetes mellitus. Other rare triggers include abdominal trauma or injuries during diagnostic-therapeutic interventions or infections (e.g. mumps).
In naturopathy, disorders of the intestinal mucosa are also considered for diseases of the pancreas. Intestinal allergies, intestinal dysbiosis and leaky gut syndrome lead to a decrease in the intestinal mucosa, which also has an impact on the precursors for enzyme formation and pancreatic activation. This can favor the development of pancreatitis due to the causes mentioned.
In addition to the patient survey, which deals with possible risk factors and triggers, and the clinical examination with palpation of the abdomen, imaging methods (ultrasound, and possibly endosonography and other methods) are primarily used. The determination of certain blood values (laboratory) also plays a role in the diagnosis of pancreatitis. If there is suspicion of chronic pancreatitis, a stool sample can also be used to determine the pancreatic enzyme elastase, the concentration of which can then be significantly reduced.
During the blood tests, parameters such as general inflammation values (for example C-reactive protein, short: CRP) and the pancreatic enzymes, especially the lipase, are determined. An increase in these values indicates pancreatitis, but can also have other causes. Likewise, values in the normal range do not rule out the disease. A holistic view of the individual test results is therefore important.
Due to very similar symptoms, misdiagnoses are very common, especially in the acute form, and the exclusion of other diseases (such as heart attack, appendicitis, ectopic pregnancy or pulmonary embolism and many more) is an important part of any diagnostic procedure.
Once the diagnosis of pancreatitis has been confirmed, hospitalization is usually given because the individual course, which can be relatively harmless to life-threatening, is difficult to predict. Complications can sometimes occur in the shortest possible time.
The first therapy methods focus on the respective symptoms and complications and are not cause-specific. The acute and chronic clinical pictures largely require different approaches.
Therapy for acute pancreatitis
Acute inflammation is monitored closely in the hospital (in severe cases in the intensive care unit) and, for example, the circulatory functions are continuously monitored. Digestive juices are usually suctioned off to prevent further self-digestion of the pancreas. In the early days, giving fluids via infusions is particularly important to counteract the loss of fluid. Medicines for pain are used as needed. With very severe symptoms, also opioids.
Often, and especially in the case of nausea and vomiting, or in the case of severe courses, oral food intake is temporarily replaced by enteral nutrition via probes. The period until the reconstruction of the oral diet should be kept as short as possible. Afterwards, it is important to avoid high-fat foods first and only eat small amounts. Alcohol should be avoided urgently.
In severe cases with complications and when there is a lot of dead tissue, surgery is also carried out. First, minimally invasive methods are used. If gallstones have been identified, they can be removed in different ways. If infections or other underlying diseases have become known, antibiotic therapy and other measures may still be pending during and after the acute treatment of pancreatitis.
In addition to permanently refraining from alcohol, the omission of certain medications can also be used to prevent recurrence. Complete healing is possible, but takes time and attention.
Therapy for chronic pancreatitis
In the chronic form, there is a lengthy process of illness, which, however, is rarely life-threatening. If symptoms flare up, the same treatment recommendations apply as for acute pancreatitis.
Thereafter, in the case of excretory pancreatic insufficiency, change to low-fat, carbohydrate-rich food in small portions. In addition, digestive enzymes are administered as replacements if there is a corresponding deficiency. If there is endocrine insufficiency, the blood sugar level is checked and, if necessary, balanced with small amounts of insulin and enzyme preparations, either dietetically or with medication. There may also be a need to add fat-soluble vitamins such as A, D, E and K. If accompanying pain occurs, stents can remedy the permeability of the duct systems. Medications are also used to treat pain.
In addition to endoscopic interventions, surgical interventions are sometimes used for complicated courses with dangerous sequelae. Complete healing cannot be expected. Alcohol and smoking worsen the prognosis and smoking also increases the risk of pancreatic cancer.
Naturopathic and alternative treatment options
Due to possible life-threatening complications and serious courses, it is recommended to treat every pancreatitis found conventionally and to monitor the course by a specialist.
If the course is rather mild, naturopathic treatments can be used to help alleviate symptoms and generally strengthen or relieve the pancreas. Proven home remedies include certain foods and herbs with digestive ingredients, such as apples and basil.
If the causes or underlying diseases are known, these can also be treated with naturopathic methods after successful acute therapy.
If the cause is unknown, healing methods such as acupressure, acupuncture and Bach flower therapy can be used to generally stimulate the self-healing powers. To fight infections, propolis tincture (liquid bee resin) is recommended, among other things, which can be used internally and externally (rubbing the upper abdomen).
If there are only slight blood sugar derailments, these can sometimes be compensated for with phytotherapy, for example with preparations made from blueberry leaves, yarrow or bean shells.
If there is an alcohol addiction among those affected, after a withdrawal treatment, long-term healing can be supported in naturopathic practice by systemic advice, client-centered conversation therapy, solution-oriented hypnosis, psychokinesiology and other alternative methods. (jvs, cs)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- Pschyrembel: Clinical dictionary. 267th, revised edition, De Gruyter, 2017
- Herold, Gerd and co-workers: internal medicine. Self-published by Gerd Herold, 2019
- German Society for Digestive and Metabolic Diseases (DGVS): S3 guideline on chronic pancreatitis: definition, etiology, diagnostics and conservative, interventional endoscopic and operative therapy of chronic pancreatitis. As of August 2012 (under review). AWMF register No. 021/003, awmf.org
- Huber, Wolfgang and Schmid, Roland M .: Acute pancreatitis. Evidence-based diagnostics and therapy, in: Deutsches Ärzteblatt, volume 104/2007, number 25, aerzteblatt.de
- Endlicher, Esther and Mössner, Joachim: The pancreas and its diseases, in: Guide series of the Gastro-Liga e.V., as of January 2017, gastro-liga.de
- Simon, Peter, Mayerle, Julia and Lerch, Markus M .: Chronic pancreatitis, in: Guide series of the Gastro-Liga e.V., as of September 2016, gastro-linga.de
ICD codes for this disease: K85, K86ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.