From the Guidelines
Pancreatitis in non-drinkers is most commonly caused by gallstones, which can block the pancreatic duct and lead to the digestive enzymes attacking the pancreas itself. According to the American Gastroenterological Association (AGA) Institute medical position statement on acute pancreatitis 1, the etiology of acute pancreatitis should be established in at least three fourths of patients, and the initial history should focus on previous symptoms or documentation of gallstones, hypertriglyceridemia, or hypercalcemia, among other factors.
Other potential causes of pancreatitis in non-drinkers include:
- Certain medications, such as antibiotics, diuretics, immunosuppressants, and anti-seizure drugs
- Hypertriglyceridemia, particularly when triglyceride levels exceed 1,000 mg/dL, as stated in the American Heart Association scientific statement on triglycerides and cardiovascular disease 1
- Autoimmune conditions that cause the body's immune system to attack the pancreas
- Genetic mutations, such as those in the PRSS1, SPINK1, or CFTR genes, which can predispose individuals to pancreatitis
- Anatomical abnormalities of the pancreas, such as pancreas divisum
- Certain infections, trauma to the abdomen, and endoscopic procedures like ERCP
It is essential to note that, in some cases, despite thorough investigation, the cause of pancreatitis remains unknown, termed idiopathic pancreatitis. If symptoms like severe abdominal pain, nausea, or vomiting occur, it is crucial to seek immediate medical attention, as pancreatitis can be life-threatening if left untreated. The AGA Institute medical position statement 1 recommends that all patients with acute pancreatitis should have serum obtained for measurement of amylase or lipase level, triglyceride level, calcium level, and liver chemistries, and that abdominal ultrasonography should be obtained at admission to look for cholelithiasis or choledocholithiasis.
From the Research
Causes of Pancreatitis in Non-Drinking Individuals
- Hypertriglyceridemia is a potential cause of acute pancreatitis, as seen in patients with severe hypertriglyceridemia-related acute pancreatitis 2.
- Other causes of acute pancreatitis include gallstone migration, pancreas divisum, and complications of endoscopic retrograde cholangiopancreatography 3.
- Valproic acid, a medication used to treat epilepsy, has been associated with acute pancreatitis in some patients, with a high fatality rate 4, 5.
- The etiology of acute pancreatitis can be highly variable, and it is essential to identify the causing factor to provide specific treatment and prevent relapses 6.
Risk Factors
- Hypertriglyceridemia, pancreas divisum, and valproic acid use are potential risk factors for acute pancreatitis in non-drinking individuals 2, 3, 4, 5.
- Other factors, such as inborn errors of metabolism, familial hypertriglyceridemia, and certain medical conditions, may also contribute to the development of acute pancreatitis 2.
Diagnosis and Treatment
- Diagnosis of acute pancreatitis typically involves laboratory tests, such as serum lipase and amylase levels, and imaging studies 2, 3, 5.
- Treatment of acute pancreatitis may involve lipid-lowering agents, insulin, and other medications, as well as therapeutic plasma exchange in severe cases 2.
- In cases of valproic acid-associated pancreatitis, rechallenge with the medication is generally not recommended due to the high risk of relapse 4, 5.