From the Guidelines
Pancreatitis is primarily caused by gallstones and alcohol abuse, and its management should focus on supportive care, pain control, and nutritional support to improve morbidity, mortality, and quality of life. The causes of pancreatitis can be divided into acute and chronic forms, with acute pancreatitis typically caused by gallstones (40-70% of cases), alcohol abuse (25-35%), medications, hypertriglyceridemia, hypercalcemia, trauma, and post-ERCP complications 1. Chronic pancreatitis is predominantly caused by long-term alcohol abuse (70-80% of cases), genetic factors, autoimmune conditions, and recurrent acute pancreatitis.
Causes of Pancreatitis
- Gallstones: 40-70% of acute pancreatitis cases
- Alcohol abuse: 25-35% of acute pancreatitis cases, 70-80% of chronic pancreatitis cases
- Medications: such as thiazide diuretics, steroids, and certain antibiotics
- Hypertriglyceridemia: levels >1000 mg/dL
- Hypercalcemia
- Trauma
- Post-ERCP complications
- Genetic factors: mutations in PRSS1, SPINK1, or CFTR genes
- Autoimmune conditions
Management of Pancreatitis
- Supportive care: aggressive IV fluid resuscitation, pain control with opioid analgesics, and bowel rest
- Nutrition: reintroduced early, preferably via oral route if tolerated, or enteral feeding if necessary
- Severe cases: ICU monitoring, antibiotics, and interventional drainage for complications like infected necrosis
- Chronic pancreatitis: pain control with acetaminophen, NSAIDs, or opioids, pancreatic enzyme replacement therapy, and addressing nutritional deficiencies
- Alcohol abstinence and smoking cessation are crucial for both forms to prevent recurrence and progression
- Endoscopic or surgical interventions may be needed for complications like pseudocysts, ductal strictures, or when medical management fails to control symptoms, as recommended by the 2019 WSES guidelines for the management of severe acute pancreatitis 1.
According to the most recent and highest quality study, the ESPEN guideline on clinical nutrition in acute and chronic pancreatitis (2020), nutritional support is essential in the management of pancreatitis, and patients with chronic pancreatitis should be considered at risk, screened, and supplemented accordingly 1. Additionally, the 2017 study on negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis highlights the importance of addressing nutritional deficiencies and osteoporosis in patients with chronic pancreatitis 1.
From the Research
Causes of Pancreatitis
- The main causes of acute pancreatitis are gallstones and excessive alcohol consumption 2, 3, 4, 5.
- Significantly elevated serum triglyceride levels can also precipitate episodes of acute pancreatitis 2, 6.
- Genetic defects, poorly controlled diabetes, obesity, and high-fat diets can contribute to elevated triglyceride levels and increase the risk of pancreatitis 2.
- Other causes of acute pancreatitis include hypertriglyceridemia, endoscopic retrograde cholangiopancreatography (ERCP), and biliary disease 5, 6.
Management of Pancreatitis
- Treatment of hypertriglyceridemia-induced acute pancreatitis consists of immediate reduction in serum triglyceride levels and long-term medications and lifestyle modifications 2.
- Management of acute pancreatitis includes fluid resuscitation and hydration maintenance, pain control, and early feeding 3, 5.
- Feeding recommendations have changed, and oral feeding should be initiated within the first 24 hours, as tolerated 3.
- Antibiotics are indicated only with radiologically confirmed infection or systemic infection symptoms 3.
- Surgical or endoscopic interventions are needed for biliary pancreatitis or obstructive pancreatitis with cholangitis 3, 5.
- Early diagnosis and intervention in patients with chronic pancreatitis may prevent irreversible pancreatic damage 5.