Pancreatitis

The most common symptom, whether acute or chronic, is intense pain in the upper abdomen, often radiating to the back.
In acute pancreatitis, the pain may come on suddenly or gradually, last for several days, and be accompanied by nausea, vomiting, fever, a swollen and tender abdomen, and a rapid heartbeat.
The chronic form, on the other hand, often manifests as persistent or recurring abdominal pain, aggravated after meals, but can also develop into digestive disorders related to enzyme deficiency: fatty and foul-smelling stools, diarrhea, unintentional weight loss, and sometimes a total absence of pain.

Pancreatitis occurs when digestive enzymes that are normally activated in the intestine are activated too early inside the pancreas. This phenomenon causes the pancreatic tissue to digest itself and triggers an inflammatory reaction.

Several factors can increase the risk of developing pancreatitis:

• Alcohol: excessive consumption is associated with many cases, both acute and chronic.
• Tobacco: smokers are three times more likely to develop chronic pancreatitis; quitting reduces this risk.
• Obesity: a body mass index (BMI) greater than or equal to 30 increases the likelihood of occurrence.
• Gallstones and metabolic disorders: the presence of gallstones, diabetes, excess triglycerides or calcium in the blood, as well as certain autoimmune diseases are recognized factors.
• Genetic predisposition: mutations (e.g., PRSS1 gene) or a family history of pancreatitis increase the risk.
• Demographic factors: Men and African Americans are at greater risk.
• Age: Chronic pancreatitis most often occurs between the ages of 30 and 40, but the acute form can occur at any age, including in children, among whom the incidence is increasing.
• Certain medications

The diagnosis of pancreatitis is based on clinical, biological, and radiological examinations. Doctors begin by asking the patient about their symptoms, personal and family history, and lifestyle habits, including alcohol and tobacco use. The clinical examination looks for abdominal pain, tenderness on palpation, or associated signs such as fever or jaundice (jaundice).
Biological analyses are an essential step. Lipase or amylase levels at least three times higher than normal are highly suggestive of acute pancreatitis.
Finally, medical imaging completes the diagnosis and searches for the cause. Abdominal ultrasound is the first-line test for detecting gallstones. Other techniques, such as computed tomography (CT scan), MRI, and/or endoscopic ultrasound, can be used to assess the extent of the damage, detect more subtle abnormalities, and investigate the cause of the pancreatitis.

Treatment varies depending on whether the condition is acute or chronic, but is primarily based on supportive care. Acute pancreatitis usually requires hospitalization to ensure intravenous rehydration, pain management, and close monitoring. Pancreatic rest is recommended at the onset of the disease: food intake is suspended for 24 to 48 hours, then gradually resumed. When oral feeding is not possible, enteral tube feeding is preferred because it reduces the risk of infection compared to intravenous nutrition. Painkillers, often opioids, are used to control the sometimes very intense pain. Antiemetics may be prescribed for nausea and vomiting.

Prevention of phlebitis or venous embolism is often necessary.

At the same time, it is essential to identify and treat the cause. If gallstones are responsible, endoscopic sphincterotomy (ERCP) and/or gallbladder surgery (cholecystectomy) may be recommended. If the cause is metabolic (hypertriglyceridemia, hypercalcemia), specific measures are taken. In chronic forms, treatment is often long-term. It includes enzyme supplements to improve digestion, nutritional monitoring, appropriate painkillers and, if necessary, endoscopic or surgical procedures to relieve obstruction or remove damaged pancreatic tissue.

The majority of acute pancreatitis cases are benign and respond well to appropriate treatment. However, approximately 15 to 20% of patients develop a severe form that can be life-threatening.

Acute complications include kidney failure, respiratory problems, pancreatic infections, and the formation of fluid-filled pseudocysts that can become infected or rupture.

Chronic pancreatitis, on the other hand, gradually leads to exocrine and endocrine pancreatic insufficiency. This results in malabsorption of nutrients, weight loss, malnutrition, and diabetes due to the destruction of insulin-producing cells. Finally, chronic inflammation is recognized as a risk factor for pancreatic cancer, with an estimated increased risk of between 1 and 2% in patients with chronic pancreatitis.

Prevention is largely based on adopting healthy behaviors. Stopping alcohol consumption is one of the most effective measures, as alcohol is responsible for a large number of cases of both acute and chronic pancreatitis. Similarly, smoking cessation helps reduce the risk, particularly of chronic pancreatitis. Maintaining a healthy weight also reduces the risk of gallstones, a common cause of pancreatitis. A balanced diet, rich in fiber and low in saturated fat, limits the development of these stones. Managing diabetes and monitoring triglyceride and calcium levels in the blood are also an integral part of prevention measures. Finally, for people with a family history of pancreatitis or a genetic predisposition, regular medical monitoring is essential for early detection of any signs of inflammation.

Pancreatitis can quickly progress to severe forms. It is therefore recommended that you seek emergency medical attention if you experience sudden, intense, and persistent abdominal pain, especially if it radiates to your back. The onset of fever, nausea, vomiting, or jaundice (yellowing of the skin and eyes) should also be cause for concern. These symptoms may be signs of a serious infection, obstruction, or life-threatening complication. Delaying consultation can have serious consequences.

At Hôpital de La Tour, the treatment of pancreatitis is part of a multidisciplinary approach that combines the skills of gastroenterologists, radiologists, surgeons, intensivists, and nutritionists. With its emergency department available 24/7, the hospital ensures a rapid and appropriate response to patients presenting with acute abdominal pain suggestive of pancreatitis.

Is pancreatitis a common disease?
Yes. It is one of the leading causes of hospitalization for digestive disorders. Acute pancreatitis is being diagnosed more and more, particularly in connection with the increase in obesity and gallstones.

What is the difference between acute and chronic pancreatitis?
The acute form appears suddenly and disappears within a few days with treatment, while the chronic form develops over several years, causing irreversible damage and persistent digestive problems.

What are the most common causes?
Gallstones and excessive alcohol consumption alone account for nearly 80% of cases.

Can pancreatitis be prevented?
Yes, in part. Avoiding alcohol, quitting smoking, maintaining a healthy weight, and monitoring blood triglyceride and calcium levels reduces the risk.

What are the typical symptoms?
Upper abdominal pain radiating to the back is the most common sign. It may be accompanied by nausea, vomiting, fever, rapid pulse, or yellowing of the skin.

How is acute pancreatitis treated?
Treatment involves hospitalization with intravenous rehydration, painkillers, rest for the pancreas, and treatment of the cause, such as removal of gallstones.

What complications can occur?
These range from kidney and respiratory failure to pancreatic infections, pseudocysts, necrosis, malnutrition, diabetes, and an increased risk of pancreatic cancer.