Coping with Pancreatitis

Pancreatitis treatments and complications

/ Author:  / Reviewed by: Chris Galloway, M.D.

Pancreatitis, a disorder caused by the inflammation of the pancreas, can sometimes just be a bout of illness that only lasts a few days (called acute pancreatitis).

In other cases, called chronic pancreatitis, the symptoms and issues relating to the disorder can linger for years.

For patients of both forms, there is plenty to learn about potential complications, traditional treatments and new options on the horizon.

It's Complicated

According to the Mayo Clinic, there is a variety of potential complications for patients with pancreatitis, some of which seem obviously related, others, more surprising.

Infection of the pancreas is one less surprising complication. Acute pancreatitis can weaken the organ, making it more vulnerable to bacteria. In serious cases, removal of infected portions of the pancreas are required.

Pseudocysts, in which debris and fluid are captured in pockets on the pancreas, also sometimes results from acute pancreatitis. Infections and internal bleeding can result from the rupture of large pseudocysts.

For patients of both forms, malnutrition is a potential risk, as the pancreas (which produces enzymes that aid in digestion and the absorption of nutrients) slows down its functioning. Diarrhea and weight loss can both be seen, even if no dietary changes occur.

The pancreas also contains cells that produce insulin. Damage to these cells can affect the way the body handles blood sugar and cause diabetes.

For some, breathing problems can occur as, according to the Mayo Clinic, "Acute pancreatitis can cause chemical changes in your body that affect your lung function, causing the level of oxygen in your blood to fall to dangerously low levels."

Chronic pancreatitis, and the long-term inflammation of the organ that comes along with it, can also be a risk factor for pancreatic cancer later in life, reports the Mayo Clinic.

Treating the Disorder

When pancreatitis is detected, there are usually several steps or levels of treatment that occur. First, the patient needs to be stabilized, then the contributing causes of the disorder addressed, then, if the disorder is chronic, long-term treatment options may be implemented.

Stabilization

Initial treatments are aimed at calming the inflamed organ and making the patient feel more comfortable. These treatments sometimes require a few days of hospitalization.

Often patients are required to fast, or stop eating, for a few days in order to allow the pancreas to recover. Clear liquids and bland foods are reintroduced first, then eventually, a normal diet.

IV (intravenous) fluids are often required, because "as your body devotes energy and fluids to repairing your pancreas, you may become dehydrated," reports the Mayo Clinic.

Pain medications are also often prescribed and administered to pancreatitis patients upon initial stabilization.

Underlying Causes

The next step is typically to determine and treat any underlying causes. This phase of treatment varies from patient to patient, since the reasons for developing pancreatitis can vary as well.

For some, pancreatitis can be caused by the abuse or overuse of alcohol. In these cases, treatment for alcohol dependence may be necessary.

Other patients may require gallbladder surgery if gallstones are to blame, or pancreas surgery to remove tissue or drain fluid.

In some, pancreatitis is caused by a blocked bile duct. In these cases, procedures to clear the blockages, called endoscopic retrograde cholangiopancreatograpy (ERCP) are required. In an ERCP, a long tube with a camera is used to aid in the process.

Long-term Treatments

For the long-term management of chronic pancreatitis, doctors may recommend further treatments, but this depends on each individual patient.

For some changes to diet are required to keep healthy. Others may be prescribed pancreatic enzyme supplements to aid the gland in its work of digesting and processing food.

Additionally, medications or surgery may be required to help manage pain. For some with chronic pancreatitis, regular and difficult abdominal pain may be experienced. Medication or nerve surgery may help in these cases.

Changing Treatments

Two 2010 studies published in the journal Clinical Gastroenterology and Hepatology examined the possibility that combining multiple less invasive treatments might actually be more effective than traditional treatments for pancreatitis.

Additionally, the authors of these studies suggest that not only are the treatments more effective for healing the pancreas, but they also require less exposure to radiation, shorter hospital stays and less surgery for patients.

One study, led by Michael Gluck, MD, from the Virginia Mason Medical Center, looked at a pancreatitis complication called walled-off pancreatic necrosis (WOPN.)

Cases of WOPN can lead to infections, blockages, blood vessel issues and further complications in patients. These cases often require long hospital stays, surgeries and procedures using radiation.

In this study, needle fluid drainage ("standard percutaneous drainage" or SPD), the traditional treatment, was compared to "combined modality therapy" (CMT), in which a less invasive endoscopic treatment through the intestine was added to the drainage treatment.

Sixty-six WOPN patients were followed for three years, 43 of whom were treated with SPD, 23 of whom were treated with CMT.

Factors like duration of hospital stay, time of drainage, complications, number of procedures and severity of the disorder were compared.

Results showed that CMT patients on average had shorter hospital stays (26 versus 55 days), shorter time of drainage (83.9 versus 189 days) and fewer scans using radiation (6.5 versus 13). Furthermore, these patients had fewer complications than their SPD counterparts.

"Until a large, multi-center, randomized trial is conducted, this current study adds another seemingly effective and safe management technique for symptomatic walled-off pancreatic necrosis with the added benefit of reducing length of hospitalization and use of radiological resources," said Dr. Gluck.

Another study, led by Pramod Kumar Garg, MD, from the All India Institute of Medical Sciences in New Delhi, India explored treatments in a different type of severe pancreatitis.

One potential complication of acute pancreatitis is the presence of dead pancreatic tissue, also called infected pancreatitis necrosis.  The traditional treatment for this is surgery to remove the tissue.

In this study, Dr. Garg and team looked at the results of this traditional treatment compared to "primary conservative treatment" (PCT).

In these PCT cases, patients are kept in the intensive care unit and given treatments of organ support, antibiotics, nutritional support and SPD when necessary.

To compare the results of these two treatment groups, 80 patients with pancreatitis were followed. Twenty-eight of these patients were treated with traditional surgery and 52 were treated with PCT.

Results showed similar mortality rates in both groups. Furthermore, 76 percent of the PCT patients managed to avoid surgery and 54.5 percent of the PCT cases were treated successfully with this treatment.

"Until now, there has not been a trial comparing conservative and surgical therapy in patients with infected pancreatitis necrosis because conservative management was never considered a viable treatment option. We were able to demonstrate that throughout the course of 10 years, those who received primary conservative treatment had significantly higher survival rates than those who underwent surgery," said Dr. Garg.

Future larger scale studies will need to be completed to confirm the effectiveness of these less invasive treatment options.

These options will continue to vary with the individual cause and case found in each patient. However, these studies do show a possibility on the horizon for potentially less surgeries and hospital times for patients.

Reviewed by: 
Review Date: 
September 28, 2012