Pancreatitis is an inflammation of the pancreas. Two forms can be distinguished: acute and chronic. What are the causes, symptoms and treatment options? We talk about this topic with Professor Alessandro Zerbi, Head of Pancreatic Surgery at Humanitas.
“Acute pancreatitis begins suddenly and it is a very variable disease, which can be mild or severe. It usually manifests itself in a violent pain that affects the higher quadrants of the abdomen and often radiates to the back. There may also be vomiting and an impairment of the general condition due to pain.
The most frequent cause of acute pancreatitis is gallbladder stones and in some cases acute pancreatitis is the first sign of gallbladder stones. Another cause, although less relevant than the first, is the abuse of alcohol, understood as an episode of excessive consumption of alcohol,” says Professor Zerbi.
“Chronic pancreatitis is a persistent inflammation, mainly due to alcohol abuse. It is a very common condition in the countries of central and northern Europe, while it is less widespread in Italy. Young men in particular are affected, although there has been an increase in the number of female cases. It is a disabling disease, which despite the treatment is not currently possible to regress, but at most stabilize. Chronic pancreatitis is an important risk factor for pancreatic cancer in the long run.
The pathology manifests itself with a pain that in the initial phases of the disease is mild, then becomes more and more intense, localized at the high quadrants of the abdomen, between the navel and the sternum; a pain that has a belt arrangement and that often extends posteriorly to affect the back. Initially, the pain appears after eating, but in the most advanced forms the pain becomes constant to the point of forcing the patient to continue to take even more painkillers,” explains the specialist.
How do you intervene?
“In patients with mild acute pancreatitis (about 85% of cases) 2-3 days of fasting and IV administration are sufficient to supply the body with the lost fluids. More complex treatment options are needed in more serious cases; hospitalization may also be necessary, sometimes even in intensive care if the damage has affected many other organs (such as kidney, lung, circulatory system).
Today, the approach is more conservative than in the past: where possible, medical, endoscopic or radiological treatment is preferable to surgical treatment.
In patients with chronic pancreatitis, lifestyle changes must be made first, limiting alcohol intake and smoking, which often acts as a contributory factor. The role of nutrition is also important: in fact, patients with chronic pancreatitis often do not eat adequately; moreover, the intake of substitute pancreatic enzymes could be indicated to improve the absorption of food; in fact, these patients produce less juice and enzymes and suffer from a lower absorption of what they eat.
The therapy is therefore first medical-behavioral and if necessary endoscopic, with the insertion of stents inside the pancreas to facilitate the outflow of pancreatic juice. In the most advanced forms, surgery may be necessary, which may also include the removal of part of the pancreas,” the professor said.
The role of power supply
“Nutrition plays an important role in the health of the pancreas and the Mediterranean diet is a good reference. It is preferable to consume foods rich in lean proteins (white meat, fish), limiting the consumption of animal fats and sugars. The green light for fruits and vegetables, whole grains, legumes, semi-skimmed or skimmed milk, foods rich in antioxidants such as green leafy vegetables, blueberries, grapes, sweet potatoes, carrots, nuts and pomegranates,” concluded Professor Zerbi.