When pancreatitis hits, it usually starts as a sudden, intense pain in the abdomen, a kind of discomfort that can land you in the ER. If left to progress, this condition can become lifelong. Pancreatitis impacts about 20 in 100,000 individuals worldwide, leading to substantial physical discomfort and various possible health complications. Yet, it's possible to manage pancreatitis effectively with the right approach. 

Routine monitoring and proper care can help keep the condition in check, lessen the discomfort, and reduce the likelihood of complications. In this article, we will discuss the causes of pancreatitis, what symptoms look like, and provide diagnostic and bi-annual monitoring strategies related to pancreatitis in order to treat patients with this condition more effectively.   

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What is Pancreatitis? 

Pancreatitis is a medical condition characterized by the inflammation of the pancreas, a long, flat gland located behind the stomach in the upper abdomen. The pancreas plays an integral role in digestion and glucose regulation, producing enzymes to aid in the digestion of proteins, carbohydrates, and fats and releasing hormones like insulin and glucagon into the bloodstream to control sugar usage.

The pancreas is supposed to release digestive enzymes into the small intestine, where they become active. However, when these enzymes mistakenly activate within the pancreas, they can cause damage to the pancreatic tissue, leading to inflammation and swelling, a condition known as pancreatitis. This malfunction is due to a disorder in the pancreas's exocrine function, the portion of the organ involved in the production of digestive enzymes.

Pancreatitis can present as either acute or chronic. Acute pancreatitis appears suddenly and lasts for days, whereas chronic pancreatitis develops over many years and often results from multiple episodes of acute pancreatitis. While mild cases of pancreatitis may improve with proper treatment, severe cases can potentially lead to life-threatening complications (2,3,4).

The pathogenesis of pancreatitis, both acute and chronic, can be triggered by a variety of mechanisms. For instance, alcohol can induce acute pancreatitis through its direct toxicity and immune responses. Furthermore, gallstones can cause temporary blockages in the pancreatic duct; a mechanism also linked to pancreatitis induced by endoscopic retrograde cholangiopancreatography (ERCP). Over time, repeated episodes of acute pancreatitis can result in chronic inflammation, leading to fibrosis and a consequent reduction in the pancreas's functioning capacity (2,3,4).

What Causes Pancreatitis?  

Pancreatitis is typically triggered when digestive enzymes become activated within the pancreas, leading to tissue injury and inflammation. A variety of environmental, lifestyle, and genetic factors can influence the pancreas's ability to properly produce and distribute its enzymes (2,3,4).

Long-term alcohol abuse is one of the leading causes of pancreatitis. Alcohol increases the permeability of pancreatic ducts, causing digestive juices to leak into and damage the tissue. Another significant contributor to pancreatitis is the presence of gallstones. When small gallstones migrate from the gallbladder to the common bile duct and block the pancreatic duct, it can trigger the activation of pancreatic enzymes and lead to tissue damage (2,3,4).

Beyond these two major causes, other factors contributing to pancreatitis include hyperlipidemia (increased levels of triglyceride fats in the blood), hypercalcemia (high levels of calcium in the blood), certain medications, abdominal surgery or trauma, and various bacterial and viral infections. Some rare causes encompass biliary sludge and microlithiasis, biliary obstruction, vascular disease-causing pancreatic ischemia, anatomic abnormalities, and idiopathic causes (2,3,4).

Specific medications linked to acute pancreatitis include azathioprine, 6-mercaptopurine, didanosine, valproic acid, angiotensin-converting–enzyme inhibitors, and mesalamine. Genetic risks include mutations in PRSS1, CFTR, and SPINK1 genes. In the absence of gallstones or significant alcohol use, high triglyceride levels (greater than 1000 mg/dl) may be considered as a cause (2,3,4).

Chronic pancreatitis is most commonly caused by ethanol abuse, with smoking being another significant risk factor. Other causes can include tropical pancreatitis, idiopathic pancreatitis, ductal obstruction due to factors like pancreas divisum, pseudocysts, stones, tumors, and trauma, mutations in cystic fibrosis genes, hereditary pancreatitis, and systemic diseases such as systemic lupus erythematosus (2,3,4).

Pancreatitis Symptoms

The symptoms of pancreatitis can vary, depending on whether it's acute or chronic. Here are the main symptoms for each type (2,3,4).:

Acute Pancreatitis

• Abdominal pain: This is the most common symptom, which can be short-lived, lasting a few hours to days. It may radiate to the back or occasionally to the chest and may worsen with drinking alcohol or eating.
• Nausea
• Vomiting
• Fever
• A swollen, tense, and tender abdomen
• Pain can lead to a decreased appetite, which may result in weight loss, potential dehydration, and malnutrition.

Chronic Pancreatitis

• Constant and often severe pain in the upper abdomen: This pain often radiates to the back.
• Diarrhea with greasy stools (steatorrhea): This occurs due to difficulty digesting fat.
• Weight loss: The pancreas may not release enough enzymes to properly break down food, leading to weight loss.
• Abdominal pain that feels worse after eating

While the symptoms are similar for acute and chronic pancreatitis, chronic pancreatitis develops gradually and persists over many years. It's also important to note that some cases of acute pancreatitis can become chronic (2,3,4).

What Are The Benefits of Regular Lab Testing for Patients with Pancreatitis?

Regular lab testing is crucial for patients with pancreatitis, as it helps monitor the condition, detect complications, and guide treatment decisions. Lab tests can help diagnose and assess the severity of pancreatitis, as well as identify its underlying causes.

Blood tests are commonly used to measure levels of pancreatic enzymes, such as amylase and lipase. Elevated levels of these enzymes can indicate inflammation in the pancreas and help confirm a diagnosis of pancreatitis. Additionally, blood tests can detect signs of infection or inflammation in the bile ducts, pancreas, gallbladder, or liver, which may be contributing factors to pancreatitis (5,6).

Regular lab testing can also help monitor the effectiveness of treatment and detect complications related to pancreatitis. For example, blood tests can reveal changes in liver enzymes and blood glucose levels, which can indicate complications or the need for adjustments in treatment.

In chronic pancreatitis, lab tests can help assess the pancreas's ability to produce digestive enzymes and hormones such as insulin. This information is essential for managing the condition and preventing malnutrition and other complications. Stool tests may also be used to measure levels of fat and enzymes, which can provide insight into the pancreas's function and the body's ability to absorb nutrients (5).

Top Labs To Run Bi-Annually On Patients With Pancreatitis

Functional medicine labs offer a variety of tests that can help tailor treatment to patients, allowing providers to optimize management strategies.

Pancreatic Enzyme Testing

Measuring levels of amylase and lipase in the blood can help diagnose pancreatitis and assess its severity. Elevated levels of these enzymes indicate inflammation in the pancreas (2).

Liver Function Testing

This test can help identify any liver-related issues that may be contributing to pancreatitis and monitor the liver's health during treatment.

Diabetes Testing 

Monitoring blood sugar levels and related biomarkers is essential for patients with pancreatitis, as the condition can affect glucose metabolism and increase the risk of complications such as diabetes.

Stool and Micronutrient Testing 

Measuring levels of fat and enzymes in the stool can provide insight into the pancreas's function and the body's ability to absorb nutrients. Pancreatitis leads to a disturbance in the functioning of the intestines, which in turn negatively impacts the intestinal barrier and the normal gut flora. This alteration in the intestinal environment permits endotoxins to enter the bloodstream. This information is particularly important for managing chronic pancreatitis and preventing malnutrition and other complications (6). 

Additional Labs to Check  

The use of abdominal ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) can be used to visualize the pancreas and identify inflammation, obstructions, or other irregularities. The regularity of imaging for those with pancreatitis, be it acute or chronic, hinges on the severity of the condition, the occurrence of complications, and the patient's clinical state. For mild acute pancreatitis, imaging is not consistently performed, and repeat CT studies are mainly warranted when clinical status alterations indicate a potential complication. In the case of chronic pancreatitis, imaging frequency can differ based on symptoms, complications, and treatment response of the patient.

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Summary

In summary, pancreatitis is inflammation of the pancreas, occurring due to malfunctioning digestive enzymes, and it presents as either acute, emerging suddenly, and lasting for a few days, or chronic, developing gradually over the years. Key causes include long-term alcohol abuse and gallstones, with other factors ranging from certain medications to genetic risks and lifestyle habits. 

Symptoms can range from abdominal pain, nausea, and fever to weight loss and greasy stools, depending on the condition's acuteness or chronicity. Regular functional medicine lab testing, including blood tests and stool tests, plays a vital role in diagnosing, monitoring, and managing pancreatitis, thus preventing potential complications.