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Pancreatitis

Inflammation of the pancreas. Gallstones or alcohol abuse most often cause this condition. Pancreatitis can be acute or chronic. Both forms are serious and can lead to complications.

PubMed Health Glossary
(Source: NIH - National Institute of Diabetes and Digestive and Kidney Diseases)

About Pancreatitis

Pancreatitis is inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum - the first part of the small intestine. The pancreas secretes digestive juices, or enzymes, into the duodenum through a tube called the pancreatic duct. Pancreatic enzymes join with bile - a liquid produced in the liver and stored in the gallbladder - to digest food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body regulate the glucose it takes from food for energy.

Normally, digestive enzymes secreted by the pancreas do not become active until they reach the small intestine. But when the pancreas is inflamed, the enzymes inside it attack and damage the tissues that produce them.

Pancreatitis can be acute or chronic. Either form is serious and can lead to complications. In severe cases, bleeding, infection, and permanent tissue damage may occur. NIH - National Institute of Diabetes and Digestive and Kidney Diseases

What works? Research summarized

Evidence reviews

Nutritional support, through the intestine (enteral) versus by injection (parenteral) for people with acute pancreatitis

The pancreas is a gland that lies behind the stomach. It produces enzymes that help digestion. Acute pancreatitis is an inflammation in the pancreas which causes severe pains in the stomach. Extra nutrition is needed to recover. However the pancreas needs rest in order to repair. Nutrition must therefore be given either by a tube into the intestines (enteral) or by injection (parenteral). This review found that patients with acute pancreatitis receiving enteral nutrition have fewer episodes of death, systemic infections, multiple organ failure and operative interventions. This data suggests that EN should be considered the standard of care for patients with acute pancreatitis requiring nutritional support.

Pancreatic enzymes for chronic pancreatitis

Chronic pancreatitis is a condition afflicting nearly 0.04% to 5% of the population worldwide. The disease presents as recurrent episodes of abdominal pain, fatty stools and weight loss, or may be asymptomatic. Patients may develop complications over a variable period of time. Medical treatment often involves prescription of pancreatic enzyme preparations for these patients. This practice is based on studies which have shown the benefit of pancreatic enzymes on various outcomes such as abdominal pain, weight loss, analgesic use, fatty stools and quality of life. However, a collective conclusion about the role of pancreatic enzymes in chronic pancreatitis patients needs to be established from these studies. This systematic review aimed to collect all published and unpublished data on this subject in order to evaluate whether pancreatic enzymes have any benefit on various parameters in chronic pancreatitis, to compare different types of enzyme preparations and to evaluate whether different dosage schedules have any influence on the various outcomes. We included 10 studies in the review. These studies had enrolled small numbers of patients. Though individual studies showed benefit of varying degrees on the parameters mentioned above, we could not pool the results of these studies. With the evidence available so far, no definitive conclusion can be drawn for the benefit of pancreatic enzymes in patients with chronic pancreatitis.

Use of antibiotics to prevent infection of dead pancreatic tissue in acute pancreatitis

Acute pancreatitis is the inflammation of the pancreas, a serious emergency with no specific treatment. The pancreas, a digestive gland, can become inflamed for many reasons, but mainly as a complication from gallstones or excess alcohol intake. If severe, the pancreas may lose its blood supply, a complication called pancreatic necrosis that can be detected by computed tomography (CT) scanning.  Death can occur either early in the disease process in association with uncontrolled inflammatory responses, causing multiple organ‐system failure (MOSF), or late when the necrotic tissue becomes infected, which might necessitate major surgery to remove the infection, with the risk of death rising from 10% to over 40%. Antibiotics may prevent later infection and reduce the risk of death, but could also encourage bacterial antibiotic resistance and fungal infections. Controlled trials looking at the value of using prophylactic antibiotics have produced conflicting results.

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Summaries for consumers

Nutritional support, through the intestine (enteral) versus by injection (parenteral) for people with acute pancreatitis

The pancreas is a gland that lies behind the stomach. It produces enzymes that help digestion. Acute pancreatitis is an inflammation in the pancreas which causes severe pains in the stomach. Extra nutrition is needed to recover. However the pancreas needs rest in order to repair. Nutrition must therefore be given either by a tube into the intestines (enteral) or by injection (parenteral). This review found that patients with acute pancreatitis receiving enteral nutrition have fewer episodes of death, systemic infections, multiple organ failure and operative interventions. This data suggests that EN should be considered the standard of care for patients with acute pancreatitis requiring nutritional support.

Pancreatic enzymes for chronic pancreatitis

Chronic pancreatitis is a condition afflicting nearly 0.04% to 5% of the population worldwide. The disease presents as recurrent episodes of abdominal pain, fatty stools and weight loss, or may be asymptomatic. Patients may develop complications over a variable period of time. Medical treatment often involves prescription of pancreatic enzyme preparations for these patients. This practice is based on studies which have shown the benefit of pancreatic enzymes on various outcomes such as abdominal pain, weight loss, analgesic use, fatty stools and quality of life. However, a collective conclusion about the role of pancreatic enzymes in chronic pancreatitis patients needs to be established from these studies. This systematic review aimed to collect all published and unpublished data on this subject in order to evaluate whether pancreatic enzymes have any benefit on various parameters in chronic pancreatitis, to compare different types of enzyme preparations and to evaluate whether different dosage schedules have any influence on the various outcomes. We included 10 studies in the review. These studies had enrolled small numbers of patients. Though individual studies showed benefit of varying degrees on the parameters mentioned above, we could not pool the results of these studies. With the evidence available so far, no definitive conclusion can be drawn for the benefit of pancreatic enzymes in patients with chronic pancreatitis.

Use of antibiotics to prevent infection of dead pancreatic tissue in acute pancreatitis

Acute pancreatitis is the inflammation of the pancreas, a serious emergency with no specific treatment. The pancreas, a digestive gland, can become inflamed for many reasons, but mainly as a complication from gallstones or excess alcohol intake. If severe, the pancreas may lose its blood supply, a complication called pancreatic necrosis that can be detected by computed tomography (CT) scanning.  Death can occur either early in the disease process in association with uncontrolled inflammatory responses, causing multiple organ‐system failure (MOSF), or late when the necrotic tissue becomes infected, which might necessitate major surgery to remove the infection, with the risk of death rising from 10% to over 40%. Antibiotics may prevent later infection and reduce the risk of death, but could also encourage bacterial antibiotic resistance and fungal infections. Controlled trials looking at the value of using prophylactic antibiotics have produced conflicting results.

See all (36)

More about Pancreatitis

Photo of an adult

See Also: Acute Pancreatitis, Chronic Pancreatitis

Other terms to know:
Enzymes, Hormones, Pancreatic Duct

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