Video: Pancreatitis Caused By “Complex Genetics,” Brings Extreme Pain

In this video, Dr. David C. Whitcomb, Chief of the Division of Gastroenterology, Hepatology and Nutrition at the University of Pittsburgh Medical Center, describes the “complex genetics” underlying pancreatitis, as well as the personalized care that UPMC offers.

Dr. Whitcomb also explains why pancreatitis is so painful and debilitating — something patients know well but often have a hard time getting others to understand.

UPMC is one of the leaders when it comes to pancreatitis diagnosis and treatment.  They play a large role in and its Pancreas Education and Research Newsletter (with the passably clever acronym PEaRL), as well as the annual PancreasFest conference.  They are clearly worth watching when it comes to new research and novel approaches to care.

One Acute Pancreatitis Attack Can Lead to Chronic Problems

A study just published in this month’s Journal of Gastrointestinal Surgery has found that a single episode of acute alcoholic pancreatitis can have effects that last for years, often leading to further attacks or to chronic pancreatitis.

The study, conducted in Finland, followed 44 patients who suffered an acute attack, tracking them 3 months later, as well as 2, 7 and 9 years after the attack. After three months, 32% of the patients had recovered to the point of showing normal findings; 52% still had acute symptoms, and 16% showed chronic change.  Given how serious an acute episode is, that is not unexpected.  What is surprising is that, seven years after the attack, only about half (53%) had recovered; the other 47% exhibited chronic changes, including pancreatic cysts in over a third of that population (36%).  By year seven 22% had experienced another acute attack and 11% had been diagnosed with chronic pancreatitis.

Notably, only six of the 44 patients had abstained from alcohol during the seven year period.  Of those, only one had chronic effects — a small number to draw statistical significance from but certainly logical.

This study certainly supports the idea that people who suffer from even one episode of acute pancreatitis need ongoing, long-term care — something they do not always get.

You can find an abstract of the study here.

When Obesity and Gallstones Lead To Pancreatitis

We are excited to present a guest post from Dr. Lisa Oldson, a physician at Northwestern Memorial Hospital specializing in Internal Medicine.  She has a blog and a YouTube Channel covering medical issues related to obesity and weight loss that are well worth visiting.    Our thanks!

What does pancreatitis have to do with obesity? Plenty. The link between the two is gallstone disease, the #1 cause of acute pancreatitis. More than 20 million people in the US have gallstones, and one of the biggest risk factors for gallstone disease is obesity. When I was in medical school, the unkind mnemonic of “female, fat and forty” was passed down from the residents to the students as a way to remember those at highest risk for gallstones. I can only hope today’s medical students are more thoughtful!

Biliary Tract

The gallbladder and the bile ducts. Also called biliary system or biliary tree. (Photo credit: Wikipedia)

Let’s start with a quick review of the anatomy and then discuss how it all works. For most of us, the gallbladder isn’t a familiar organ. This oblong pouch sits near the pancreas, just under the liver. The liver and gallbladder are located in the upper abdomen, on the right side, so gallbladder pain can be felt on the right or sometimes toward the middle of the upper abdomen. Exiting the gallbladder is a tube, or duct, that transports a liquid, called bile, into the intestines to help with digestion. Can you live without your gallbladder? Certainly, though a small percentage of people have problems with diarrhea after removal of the gallbladder.

Occasionally bile, which is made in the liver and stored in the gallbladder, clumps together to form hard stones. Some people with gallstones are unaware of these little rocks in their abdomen, but others are acutely aware, particularly when ingestion of fatty foods leads to upper abdominal pain and nausea. We don’t fully understand why gallstones form, but we do know that they occur more often in those who are obese, and we know that women are impacted more often than men.

Now it’s time to meet the pancreas. Again, let’s start with a quick review of the anatomy and how it works. The head of the pancreas begins near the gallbladder on the right side of the abdomen. It stretches across the top of the abdomen, behind the stomach, towards the middle, and ends on the left side. Imagine you laid a banana across the top of the abdomen. That gives you a rough sense of the size and shape of the pancreas.

The pancreas has a tube, or duct, that connects to the tube leaving the gallbladder. This larger tube (formed by the common bile duct from the gallbladder and the pancreatic duct from the pancreas) dumps enzymes into the small intestine. These enzymes aid in digestion. In addition to helping with digestion, the pancreas also makes insulin which helps to regulate sugar (glucose) levels in the body. When insulin isn’t present in large enough amounts or when the body doesn’t respond to insulin appropriately, it leads to diabetes.

What happens when obesity leads to gallstones and then to pancreatitis? Remember, the gallbladder and pancreas each send out a tube toward the intestine, and those tubes merge into one tube. If a gallstone from the gallbladder sneaks into the tube and gets stuck, it can block the enzymes trying to leave the pancreas. These enzymes back up and become toxic, actually trying to digest the pancreas in the way they intended to digest your food. Ouch! If you’ve had pancreatitis, I don’t have to tell you that this condition can be incredibly painful. Occasionally, recurrent bouts of acute pancreatitis can lead to debilitating chronic (long term) pancreatitis.

With gallstones (and alcohol) causing the majority of pancreatitis, and obesity contributing to gallstone disease, I would be remiss if I didn’t offer a few recommendations on how to address obesity. Ironically, an extremely low calorie diet can precipitate gallstones, so if you’re embarking on a weight reduction program, please consult your health care provider for personal guidance to avoid complications that can occur from rapid weight loss.

When it comes to obesity, many people aren’t sure where to begin to take back control of their health. Research shows that tracking your food intake and activity can be highly motivational. Consider an online tracking device (many are free) that will educate you about the calories, fat, fiber, sugar and other details of your food consumption.

After you start food tracking, you should challenge yourself to move more. Ideally, that means at least 20 – 30 minutes of brisk walking daily. For those who aren’t exercising at all, even 5 minutes of walking counts as moving more! A pedometer can be a fantastic motivator as you work toward a goal of walking 10,000 steps daily.

If you’re at risk for gallstones or pancreatitis, please consult with your primary care provider to get some guidance on how you can reduce your risk.

Thanks for listening and I wish you the best of health!

Dr. Lisa Oldson

Please follow me on Twitter: @LisaOldson

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Lisa Oldson, M.D. is on staff at Northwestern Memorial Hospital in Chicago and is on the faculty at the Feinberg School of Medicine at Northwestern. She specializes in Internal Medicine and has an interest in obesity and weight management.