If all is going well, we are totally unaware of the pancreas. Doing what it should, it secretes digestive juices into the small intestine, and releases the hormones insulin and glucagon into the bloodstream. However, the digestive enzymes from the pancreas occasionally start digesting the pancreas itself, causing a painful inflammatory condition known as pancreatitis. When this happens, you know something’s wrong.
“Eighty percent of cases of acute pancreatitis are related to gallstones or alcohol use,” says Dr. Paul Buse, a Mercy Clinic gastroenterologist. “The other 20 percent of cases are related to a variety of causes, including high triglycerides, elevated calcium levels, autoimmune disease, cancer, gene mutations in the enzymes that protect the pancreas from auto-digestion, medications and trauma.”
Acute pancreatitis causes sudden onset of severe pain, but usually goes away in a few days with treatment, which may include intravenous fluids, antibiotics and pain medications.
Chronic pancreatitis, however, does not resolve on its own. “The majority of acute pancreatitis patients improve and never have issues again, whereas chronic pancreatitis patients can develop pancreatic insufficiency with vitamin deficiencies and weight loss,” says Dr. Jeffrey Kreikemeier, a St. Luke’s Hospital gastroenterologist. “They also can develop diabetes and have an increased risk of pancreatic cancer.”
The link between pancreatitis and pancreatic cancer is of particular interest to Dr. Banke Agarwal, associate professor of gastroenterology and hepatology at Saint Louis University, who was lead author of a study on the topic published in Clinical Gastroenterology and Hepatology. “Our study demonstrates that there is a much higher risk of pancreatic cancer in patients with acute pancreatitis than commonly believed,” he says.
Agarwal’s research shows that among patients older than 40 who have acute pancreatitis, 1.5 percent were eventually diagnosed with pancreatic cancer, compared to 0.13 percent of patients who had not had acute pancreatitis. Also, 55 percent of cases of pancreatic cancer diagnosed after acute pancreatitis were found within three to 24 months after the initial pancreatitis episode.
Agarwal concludes that patients older than 40 who have acute pancreatitis should be evaluated for pancreatic cancer, although he doesn’t think pancreatic cancer screening is necessarily needed for the general population. “I’m not convinced about pancreatic screening with no prior cause for concern,” he says. “Evaluation of those over 40 who have had acute pancreatitis is not the same as general screening for people who have no indication for it.”
Pancreatic cancer testing also is done in patients who have chronic pancreatitis, Buse notes. “If there is not a clear explanation for the cause of pancreatitis, particularly in the setting of relapsing pancreatitis of unknown cause, additional testing is used to more fully exclude the possibility of cancer,” he says.
Although it’s no guarantee, experts say that to reduce your risk of developing pancreatitis, limit alcohol consumption to one or two drinks per day, and maintain a healthy diet and lifestyle.