From the Guidelines
Acute pancreatitis is most commonly caused by gallstones and alcohol consumption, which together account for about 70-80% of all cases, as stated in the 2019 guidelines for the management of severe acute pancreatitis 1. The causes of acute pancreatitis can be categorized into several key areas, including:
- Gallstones, which can block the pancreatic duct and cause digestive enzymes to become trapped in the pancreas
- Alcohol consumption, which leads to pancreatitis through direct toxic effects on pancreatic cells and by causing protein plugs that block small pancreatic ducts
- Certain medications, such as azathioprine, 6-mercaptopurine, estrogens, tetracyclines, valproic acid, and thiazide diuretics
- Hypertriglyceridemia, especially levels above 1000 mg/dL
- Hypercalcemia
- Pancreatic trauma
- Post-ERCP complications
- Pancreatic tumors
- Infections Some cases are idiopathic, meaning no cause can be identified, and genetic factors can also play a role, particularly mutations in genes like PRSS1, SPINK1, and CFTR, as noted in the 2019 guidelines 1 and the AGA institute medical position statement on acute pancreatitis 1. The common pathway in all these causes involves premature activation of digestive enzymes within the pancreas rather than in the intestine, leading to autodigestion of pancreatic tissue, inflammation, and potentially severe complications if not promptly treated, as discussed in the 2019 guidelines for the management of severe acute pancreatitis 1. Key points to consider in the diagnosis and management of acute pancreatitis include:
- Establishing the etiology of the disease, which can be done in at least three fourths of patients, according to the AGA institute medical position statement on acute pancreatitis 1
- Using serum measurements, such as amylase or lipase level, triglyceride level, and calcium level, to diagnose and monitor the disease, as recommended in the 2019 guidelines for the management of severe acute pancreatitis 1
- Utilizing abdominal imaging, such as ultrasonography or CT scans, to evaluate the pancreas and surrounding tissues, as discussed in the AGA institute medical position statement on acute pancreatitis 1
- Considering the use of endoscopic ultrasonography (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) in certain cases, such as suspected gallstone pancreatitis or pancreatic malignancy, as noted in the 2019 guidelines for the management of severe acute pancreatitis 1.
From the Research
Causes of Acute Pancreatitis
- Gallstones: Gallstones are one of the most common causes of acute pancreatitis, as stated in 2, 3, 4, 5.
- Chronic alcohol use: Chronic alcohol use is another major cause of acute pancreatitis, as mentioned in 2, 3, 4, 5.
- Hypertriglyceridaemia: Hypertriglyceridaemia is a notable cause of acute pancreatitis, as stated in 3, 4.
- Drugs: Certain drugs, such as valproic acid, can cause acute pancreatitis, as reported in 6.
- Other causes: Other causes of acute pancreatitis include pancreas divisum, post-endoscopic retrograde cholangiopancreatography acute pancreatitis, and various other factors, as mentioned in 3, 4.
Risk Factors
- Pancreas divisum: Pancreas divisum is a cofactor for all forms of pancreatitis, as stated in 4.
- Hypertriglyceridemia: Hypertriglyceridemia is a cofactor for all forms of pancreatitis, as mentioned in 4.
- Alcohol abuse: Alcohol abuse is a major risk factor for acute pancreatitis, as reported in 2, 3, 4, 5.
- Gallstone disease: Gallstone disease is a major risk factor for acute pancreatitis, as stated in 2, 3, 4, 5.