From the Guidelines
Pancreatitis is primarily caused by gallstones and alcohol consumption, which together account for about 70-80% of cases. According to the most recent and highest quality study, 1, acute pancreatitis is most commonly caused by bile stones or excessive use of alcohol. Gallstones can block the pancreatic duct, causing digestive enzymes to become trapped in the pancreas where they begin to digest the organ itself. Chronic alcohol use damages pancreatic cells directly and alters pancreatic secretions.
Other Causes of Pancreatitis
Other significant causes of pancreatitis include:
- Certain medications (such as steroids, immunosuppressants, diuretics, and some antibiotics)
- High triglyceride levels (typically above 1000 mg/dL)
- Hypercalcemia
- Pancreatic tumors
- Anatomical abnormalities like pancreas divisum
- Trauma to the abdomen
- Post-ERCP complications
- Viral infections (mumps, coxsackie B)
- Autoimmune conditions Genetic factors play a role in some cases, particularly mutations in the PRSS1, SPINK1, and CFTR genes. In approximately 10-15% of cases, no clear cause can be identified, termed idiopathic pancreatitis, as noted in 1 and 1. Understanding these causes is crucial for prevention and management, as removing the underlying trigger (such as gallstone removal or alcohol cessation) can prevent recurrent attacks.
From the Research
Causes of Pancreatitis
- The most common causes of acute pancreatitis are gallstones and excessive alcohol consumption 2, 3, 4
- Significantly elevated serum triglyceride levels can also precipitate episodes of acute pancreatitis 2
- Genetic defects, poorly controlled diabetes, obesity, and high-fat diets can contribute to elevated triglyceride levels and increase the risk of pancreatitis 2
- Alcohol consumption can cause direct damage to pancreatic tissue, but only a small percentage of active drinkers will develop pancreatitis 5
- The simultaneous presence of additional risk factors and pancreatic costressors is required to increase the risk of pancreatitis and its complications caused by alcohol misuse 5
Risk Factors
- Gallstones, particularly those 5 mm or smaller, are a major risk factor for acute pancreatitis 4
- Alcohol and smoking are major risk factors for recurrent episodes of pancreatitis 3
- Hyperlipidaemia is a risk factor for both acute and chronic pancreatitis 6
- Family history and genetic factors can also play a role in the development of pancreatitis 5
Pathophysiology
- Alcohol metabolism in the pancreas can generate fatty acid ethyl esters (FAEEs) that induce sustained elevations of cytosolic calcium, leading to inhibition of mitochondrial function, loss of ATP, and necrosis of isolated pancreatic acinar cells 6
- FAEEs can undergo hydrolysis in the mitochondria, releasing free fatty acids that exert toxic effects 6