Simply, pancreatitis is an inflammation of the pancreas and can be acute or chronic. We are going to address the acute — abrupt and of short duration — form.
There are three acute types: mild, moderate and severe. Those with the mild type don’t have organ failure, whereas those with moderate acute pancreatitis experience short-term organ failure. Those with the severe type have persistent organ failure.
What makes acute pancreatitis so potentially dangerous is the surprisingly high rate of organ failure and mortality. An observational trial involving 1,005 patients found that the risk of mortality was 5 percent overall. However, in another study, when patients were hospitalized, the mortality rate was higher at 10 percent overall.
What are the symptoms?
The American College of Gastroenterology diagnosis guidelines suggest that two of three symptoms be present. These include severe abdominal pain; enzymes (amylase or lipase) that are at least three times greater than normal; and radiologic imaging that shows characteristic disease findings.
Most times, the abdominal pain is in the central upper abdomen near the stomach, and it may also present with pain in the right upper quadrant of the abdomen. Approximately 90 percent of patients also experience nausea and vomiting.
What are the risk factors?
Acute pancreatitis risk factors include gallstones, alcohol, obesity and, to a much lesser degree, drugs. Gallstones and alcohol may cause up to 75 percent of the cases.
Although medications are potentially responsible for between 1.4 and 5.3 percent of cases, making it rare, the number of medications implicated is diverse, including certain classes of diabetes therapies, some antibiotics — metronidazole (Flagyl) and tetracycline — and immunosuppressive drugs. Even calcium may potentially increase risk.
In a study using the Swedish Mammography Cohort and the Cohort of Swedish Men, results showed that central obesity is an important risk factor.
Those with a waist circumference of greater than 41 inches had a twofold increased risk of a first-time acute pancreatitis episode, compared to those with a waist circumference of 29.5 to 33.5 inches. Remember that waistline is measured from the navel, not from the hips.
The pancreas is a critical organ for balancing sugar in the body. In a meta-analysis of 24 observational trials, results showed that more than one-third of patients diagnosed with acute pancreatitis went on to develop prediabetes or diabetes.
Within the first year, 15 percent of patients were newly diagnosed with diabetes. After five years, the risk of diabetes increased 2.7-fold.
Gallstones and gallbladder sludge are major risk factors, accounting for 35 to 40 percent of acute pancreatitis incidences. Gallstones are thought to cause pancreatitis by temporarily blocking the duct shared by the pancreas and gallbladder that leads into the small intestine.
If it is gallstone-induced, surgery may help resolve pancreatitis and prevent recurrence.
Can diet have an impact?
The short answer is yes. What foods specifically? In a large observational study, results showed that there was a direct linear relationship between those who consumed vegetables and a decreased risk of non-gallstone acute pancreatitis.
For every two servings of vegetables, there was 17 percent drop in the risk of pancreatitis. Those who consumed the most vegetables — the highest quintile (4.6 servings per day) — had a 44 percent reduction in disease risk, compared to those who were in the lowest quintile (0.8 servings per day).
There were 80,000 participants involved in the study with an 11-year follow-up. The authors surmise that the reason for this effect with vegetables may have to do with their antioxidant properties, since acute pancreatitis increases oxidative stress on the pancreas.
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