Holistic pancreatitis treatment: 13 Natural Ways To Help With Pancreatitis
13 Natural Ways To Help With Pancreatitis
There are several helpful home remedies to treat pancreatitis, including the use of acupuncture, tofu, red grapes, reishi mushrooms, yogurt, spinach, ginseng, and blueberries, along with certain lifestyle changes.
Pancreatitis is an inflammation of the pancreas, a small gland that is present near the top of the abdominal cavity. When the gland becomes inflamed, the surrounding blood vessels can also get inflamed, and there may be bleeding and infection. In time, the pancreas starts to produce too much digestive juice and “digests” itself. Pancreatitis can be of two types: acute and chronic. 
In cases of chronic pancreatitis, which can go on for months or years, seeing a medical professional is strongly recommended. If left untreated, pancreatitis can result in more serious complications, such as diabetes, kidney failure, infection of the pancreas, respiratory distress, and an increased risk of pancreatic cancer. That being said, many cases of pancreatitis can be treated naturally, with some of the home remedies outlined in more detail below.
Pancreatitis refers to the inflammation of the pancreas. Photo Credit: Shutterstock
Natural Ways To Help With Pancreatitis
Let us look at the remedies for pancreatitis in detail:
The presence of free radicals can aggravate or bring about pancreatitis. One of the best free-radical-fighting foods you can eat is blueberries, which are packed with antioxidants and can reduce inflammation throughout the body very rapidly. Eating a handful of blueberries every morning can lower your risk of suffering this condition. 
Switching to tofu-based meals is a popular meat alternative for people, particularly those who suffer from chronic pancreatitis. This is because high levels of fat in the blood are one of the most common causes of pancreatitis, which can be caused by eating a lot of red meat. If you cut out high-fat foods, such as red meat, you can lower your chances of inflammation in the pancreas. 
Ginseng is one of the oldest and most trusted natural remedies for a wide variety of health issues, especially those that are inflammatory or affect the gastrointestinal system. For a case of pancreatitis, ginseng tea or ginseng root supplements can be taken to lower inflammation throughout the body and relieve pain.
Acupuncture is an ancient remedy for pancreatitis, and there are some key pressure points and areas of the body where acupuncture can relieve the pain and inflammation of this particular gland in your body.
People consume yogurt for many reasons, but it is primarily to regulate the balance of bacteria in the stomach to improve digestive efficiency and prevent infections in the gut. This can significantly strengthen the immune system, which can then work harder to reduce inflammation in other areas and glands near the stomach, such as the pancreas. 
This particular variety of mushroom is one of the most densely packed foods when it comes to antioxidants and active organic compounds that can affect our health. In pancreatitis, reishi mushrooms can soothe the stomach and bring down inflammation. 
Spinach and other leafy green vegetables are a common suggestion for someone suffering from this condition. Pancreatitis is often worsened by vitamin deficiency, specifically vitamin A, vitamin E, and vitamin C, as well as selenium. Fortunately, these essential nutrients can all be sourced in spinach, so don’t be afraid to load up a salad and enjoy the quick relief! 
When cooking, you should avoid the use of traditional vegetable oils if possible, as the fat content is not helpful for pancreatitis. However, coconut oils and other alternative cooking oils are much healthier, and have a better balance of omega-3 and omega-6 fatty acids, helping prevent the inflammation of this condition. 
Another powerful antioxidant that has been shown to work well against pancreatitis is resveratrol, which is found in high concentrations in red grapes. Not only is this a delicious remedy, but also a highly effective one! 
Cut Out Sugar
High levels of sweets, candies, cookies, and sugary foods in your diet can be a major contributing factor to pancreatitis. This can increase levels of bad fats in your blood, and also force your pancreas to work harder to compensate for the sugar in your system. This can put stress on the gland and cause it to a malfunction or become inflamed. 
Improving metabolism is key to maintaining overall health and regulating the function of the pancreas. By ensuring that you exercise regularly, your body will naturally burn off calories and prevent excessive storing of fat, which greatly lowers your risk of having an inflamed pancreas. 
The antioxidant potential of turmeric, with its active ingredient curcumin, is practically legendary. If you mix turmeric in water every morning and drink the mixture, you help eliminate all inflammatory conditions quickly and easily. 
Along the same lines of a healthier, low-fat diet and regular exercise, your ultimate goal should be to lose weight, especially if you are obese. This is a key contributing factor to pancreatitis, so do your best to shed the pounds, specifically if you suffer from a chronic version of this condition or are at high risk due to other factors. 
Word of Caution: Again, while most cases of pancreatitis clear up in a few days (or even faster with the remedies listed above), there are some potential complications if you fail to treat a chronic version of this condition. These remedies should be seen as complementary after speaking to a medical professional about more formal options for treatment.
Q and A: Natural Treatment for Pancreatitis – Mother Earth Living
I suffer from occasional severe abdominal pain. After ruling out ulcers, reflux, gallstones, and IBS, the doctor’s new theory is pancreatitis. Can you suggest any herbs to prevent these attacks?
–C. B., York, Pennsylvania
Keville responds: The pancreas produces the hormones insulin and glucagon to regulate blood sugar levels and digestive enzymes. It’s no wonder that inflammation of the pancreas causes digestive problems and pain. This organ is vital for health, so I’m glad you’re consulting a physician, as well as looking to natural remedies. First, get on a lowfat diet and avoid fried foods, saturated and hydrogenated fats, and refined sugar. Drink no alcohol, not even herbal tinctures. Turn to pills, tea or glycerite herbal extracts instead. A particularly good herb for this condition is dandelion root (Taraxacum officinale) because it improves the digestion of fats by increasing bile production. So does licorice (Glycyrrhiza glabra), which is also an excellent anti-inflammatory. (If you have high blood pressure, then look for deglycyrrhizinated licorice, or DGL.) Whatever the source of your problem, cramp bark (Viburnum opulus) will ease inflammation, cramping, and pain. Also helpful are antioxidant-rich foods such as blueberries–a traditional pancreatitis remedy. Just eating the berries is helpful, but you’ll find an even stronger antioxidant in anthocyanosides derived from bilberry fruit, which is available as a supplement. Pancreatitis is promoted by oxidative stress and the resulting production of free radicals. As a result, low levels of antioxidants can make you more prone to developing pancreatitis, and taking antioxidants (vitamins A, C, and E and selenium) helps to rid the body of free radicals and also helps reduce the pain and encourage recovery. To treat pancreatic disorders, practitioners of traditional Ayurvedic medicine prescribe Indian gooseberry (Emblica officinalis), probably because it is the richest natural source of vitamin C.
There are indications that polyunsaturated antioxidants extracted from soybeans, known as phosphatidylcholines, help protect the pancreas from damage. In addition to herbs, lecithin aids impaired fat digestion. Pancreatic enzymes such as amylase, lipase, and proteases are needed for proper digestion, so if you aren’t producing enough due to an impaired pancreas, take 500 ml at mealtime to break down certain foods.
Because your pain comes and goes, which is typical with pancreatitis, that indicates something is making it flare up. Jot notations about your eating and other habits on a calendar to get an idea of what makes it flare up. Then you can adjust your lifestyle and eating habits accordingly.
Khalsa responds: Most of the time, the inflammation of the pancreas is thought to be due to the gland being irritated by its own enzymes. In most cases the specific cause is unknown. Alcoholism or drug toxicity can bring on an acute attack of pancreatitis. About half of patients have a mechanical obstruction of the biliary tract–usually gallstones in the bile ducts. Viral infections also can cause an acute pancreas inflammation. Folks with pancreatitis often experience epigastric pain, fever, malaise, nausea, and vomiting. Mild cases, like yours, are often overlooked or misdiagnosed quite easily. There is no specific laboratory diagnostic test for acute pancreatitis. Medical treatments (other than gallstone surgery) focus on pain relief and using enzymes to substitute for the disabled pancreas. Herbalists use a multifaceted approach to handling this complex issue. Anti-inflammatories include licorice root, guggul gum, and Chinese Baikal skullcap root (Scutellaria baicalensis). Turmeric root is a standout. Start with 2 “00” capsules per day. Increase the dose to best results. For pain, try the combination of cinchona bark (Cinchona spp.) and willow bark (Salix spp.). Take 2 to 4 “00” capsules every two to four hours as necessary.
A few more clinical tidbits that sometimes help:
• Follow a diabetic diet and keep blood sugar under control
• Avoid alcohol consumption
• Limit intake of hydrogenated/saturated fats, sugar, and highly processed foods
• Increase intake of yellow and orange fruits and dark-green vegetables
• Add a multivitamin/mineral supplement
• Add chromium to control blood sugar levels and enhance insulin effectiveness
• Use lipotrophic agents–vitamin B6, vitamin B12, folic acid, choline, betaine, and methionine
• Take pancreatic enzymes with meals
Kathi Keville is director of the American Herb Association and the author of eleven herb and aromatherapy books including Herbs for Health and Healing (Rodale, 1996). She teaches seminars throughout the United States.
Karta Purkh Singh Khalsa has more than twenty-five years of experience with medicinal herbs and specializes in Ayurvedic, Chinese, and North American healing traditions. He is a licensed dietitian/nutritionist, a massage therapist, and a board member of the American Herbalists Guild.
Published on Dec 8, 2009
Keep dehydrated fruits and vegetables on hand this winter to use for tasty fruit leathers, pies, stews and so much more!
Use this recipe to preserve ginger by making an extract you can use in a heart-opening elixir.
Try this soothing herb for sweeter sleep.
Alternative, Complementary and Holistic Treatment – Pancreatica.
Although we understand the possible benefits of some alternative, complementary, or holistic treatment, this website is not strongly oriented this way. On an anecdotal basis, we have heard of positive experiences that patients have had with the treatment of symptoms related to pancreatic cancer (ductal adenocarcinoma of the pancreas) and chemotherapy involving such approaches as visualization techniques, meditation, prayer, acupuncture, massage, biofeedback, relaxation therapy, hypnotherapy acupuncture, green tea and Chinese herbs.
We are not averse to alternative, complementary, or holistic treatment modalities for pancreatic cancer in which the downside risks are minimal (or better yet, nonexistent) and which do not appear likely to interfere with other more conventional medical therapies. For example, we strongly believe that faith and hope are the two most powerful allies at one’s disposal.
The overriding concern of this website is the ancient admonition to physicians, “First do no harm. ” This site is oriented to the scientific method and to scientifically-based treatment for pancreatic cancer. If you have to take risks, our thought is at least do it under medical and scientific guidance. Nonetheless, we know that there are a large number of people who will not subscribe to this approach. To those people, we would encourage thoughtful and cautious approaches to the more gentle of the alternative, complementary, and/or holistic treatments of pancreatic cancer. And we would advise being careful.
With that warning, we note that there are sometimes clinic trials against pancreatic cancer involving unconventional alternative therapies. There are a number of researchers who are in support of these trials. Some perhaps because they think they will succeed. Others, who strongly feel that applying the scientific method to these kinds of treatments will expose their weaknesses. The cutting edge of science and medicine is an odd place where today’s truth is replaced by new unexpected findings. Only time can tell us what the outcome of these studies will finally demonstrate. We would advise being careful.
There are many sites on the Internet about alternative, complementary, or holistic treatment practices. In our attempt to suggest tempering faith and hope with rationality and care, we would advise being careful.
Some of the most common alternative, complementary and holistic drug agents and treatment modalities that have been studied for pancreatic cancer include genistein, curcumin, low dose naltrexone, and traditional Chinese herbs and therapies. We have discussed such treatment and others in our Pancreatica Blog, and include titles and dates of articles found in the medical literature (both below).
Global epidemiology and holistic prevention of pancreatitis
Knowledge of pancreatitis in the 20th century was shaped predominantly by animal data and clinical trials. Several large general population-based cohort studies and comprehensive systematic literature reviews in the 21st century have had a major effect on our understanding of pancreatitis and its sequelae. This Review provides precise and up-to-date data on the burden of acute pancreatitis, chronic pancreatitis and post-pancreatitis diabetes mellitus. Exocrine pancreatic insufficiency and altered bone metabolism following pancreatitis are also discussed. Furthermore, the article introduces a framework for the holistic prevention of pancreatitis with a view to providing guidance on strategies and intervention objectives at primary, secondary and tertiary levels. Concerted efforts by not only gastroenterologists and surgeons but also primary care physicians, endocrinologists, radiologists, pain specialists, dietitians, epidemiologists and public health specialists will be required to reduce meaningfully the burden of pancreatitis and its sequelae over the ensuing decades.
Pancreatitis refers to autodigestion of the pancreas, in which pancreatic enzymes injure pancreas tissue and lead to dysfunction of the gland, as well as remote organs and systems. The epidemiology of diseases often changes with time — for pancreatitis, this aspect is certainly true. The reasons for such changes are many: population growth and migration, change in patterns of alcohol consumption and tobacco smoking, rising rates of obesity and recognition of metabolic causes of pancreatitis, and increasing use and improving quality of imaging modalities1,2. Emerging studies have also shown that acute, recurrent acute and chronic pancreatitis often represent a disease continuum3,4. In addition, there is a growing appreciation of the effect of pancreatitis on development of metabolic disorders, such as diabetes, exocrine pancreatic insufficiency (EPI) and altered bone metabolism5,7. Hence, this Review focuses on up-to-date epidemiological data from the perspective of pancreatic inflammation as a continuum (including its sequelae). We also outline strategies that might have an effect on reducing the burden of pancreatitis and resulting metabolic disorders. Epidemiological studies are prone to biases, of which the most common is selection bias (for example, studies limited only to women or individuals of a certain ethnicity)8. Thus, throughout this Review, priority is given to population-based cohort studies conducted in general populations and comprehensive systematic literature reviews to minimize the risk of selection bias and report the most robust estimates. If such studies are not available, the most recent relevant research is reviewed.
Epidemiology of pancreatitis worldwide
The global incidence of pancreatitis cited in previous reviews was invariably presented as a wide range of estimates, mainly because they were based on a mix of primary studies that had heterogeneous study populations and varying methodological quality A systematic review by Xiao et al.9 addressed this issue by pooling data from high quality studies only — specifically, population-based cohort studies conducted in general populations. This article reported that the global pooled incidence of acute pancreatitis is 34 cases (95% confidence interval (Cl) 23–49) per 100,000 general population per year, with no statistically significant difference between men and women9. The disease predominantly affects those who are middle-aged or older10,11 (). Throughout the world, there are differences in the incidence of acute pancreatitis. The high incidence regions (that is, those with incidence more than 34 cases per 100,000 general population per year) are the North America and Western Pacific regions (as defined by the WHO). Europe as a whole is a low incidence region (29 cases per 100,000 general population per year), although it was suggested that incidence of acute pancreatitis varies across the continent with Northern and Eastern Europe being most affected12. However, it is currently difficult to compare the incidence of acute pancreatitis across Europe in a robust manner because of the lack of high quality studies from Eastern and Southern Europe. Notably, population-based data on incidence of acute pancreatitis are not available from the South America, Africa, South-East Asia and Eastern Mediterranean regions. Population-based cohort studies from these regions are eagerly awaited to appreciate fully the burden of acute pancreatitis around the globe (BOX 1).
Incidence of pancreatitis in the general population.
a | Incidence of acute pancreatitis stratified by age and sex. b | Incidence of chronic pancreatitis stratified by age and sex. Data are derived from Pendharkar et al.10,11.
Knowledge gaps and research opportunities
Epidemiology of pancreatitis
Acute pancreatitis incidence in Eastern and Southern Europe, South America, South-East Asia, Africa, and the Eastern Mediterranean
Acute pancreatitis prevalence
Chronic pancreatitis incidence and prevalence in general populations of most regions of the world
Ethnic and racial variations
Sequelae of pancreatitis
Pathogenesis of post-pancreatitis diabetes mellitus (PPDM) and identification of individuals at high risk for PPDM
Diagnostic markers for diabetes of the exocrine pancreas and its subtypes
Relationship between the endocrine and exocrine functions of the pancreas, and between the exocrine function and bone metabolism
Optimal management of post-pancreatitis diabetes mellitus, exocrine pancreatic dysfunction and osteoporosis
Holistic prevention of pancreatitis
Preventing and /or mitigating gut dysfunction and resulting severity in acute pancreatitis
Identification of markers of different stages of chronic pancreatitis
Identification of individuals at risk of recurrences and progression of pancreatitis
Pharmacological (or other) interventions to prevent recurrences of pancreatitis or progression of chronic pancreatitis
The frequency of transition from the first episode of acute pancreatitis to recurrent acute pancreatitis and chronic pancreatitis was quantified in a 2015 systematic review of high quality cohort studies with at least 1 year of follow up3. Importantly, interventional studies were excluded as interventions might modify the natural course of transition from acute to chronic pancreatitis. Recurrent acute pancreatitis developed in 21% (95% Cl 17–26%) of patients after the first episode of acute pancreatitis, and chronic pancreatitis developed in 36% (95% Cl 20–53%) of patients after recurrent acute pancreatitis (). The rates of transition were higher in men than women and in patients with alcohol-induced versus biliary pancreatitis. Age, severity of acute pancreatitis and duration of follow-up did not seem to affect the rate of transition.
Frequency of transition from first episode of acute pancreatitis to chronic pancreatitis through recurrent acute pancreatitis.
Around 21% of patients suffering a first episode of acute pancreatitis will develop recurrent acute pancreatitis. Of those developing recurrent acute pancreatitis, ~36% will develop chronic pancreatitis. Data are derived from Sankaran et al.3.
According to the systematic review by Xiao et al., the global pooled incidence of chronic pancreatitis is 10 cases (95% Cl 8–12) per 100,000 general population per year9. Notably, the incidence is statistically significantly higher among men than women, at 12 cases (95% CI 8–17) and 6 cases (95% Cl 4–8) per 100,000 general population per year, respectively. Similar to acute pancreatitis, chronic pancreatitis predominantly affects patients who are middle-aged and older10,11 (). Studies that investigate variations in incidence of chronic pancreatitis in general populations across the globe are lacking and should be priorities for future research (BOX 1).
The notion of prevalence is typically considered in the context of chronic diseases, yet the prevalence of acute conditions can also be of importance. An article published in 2016 suggests that prevalence of antibodies can be used to project the burden of infectious disease and vaccination needs in the general population13. Estimating the prevalence of acute pancreatitis has not been the focus for pancreatologists thus far, at least in part because it was believed that the overwhelming majority of patients do not develop long-term consequences. However, data suggest that even patients with mild acute pancreatitis (who represent the majority of patients with acute pancreatitis) have at least twofold higher long-term risk of diabetes mellitus than people in the general population without a history of acute pancreatitis14,15. The rising incidence of acute pancreatitis4 might further increase the frequency of dysfunction of several systems (including endocrine, exocrine and altered bone metabolism, covered in detail later) long after clinical resolution of pancreatitis. Thus, a knowledge of prevalence (that is, cases with a prior history of acute pancreatitis) might enable quantification of the predicted burden of sequelae attributable to acute pancreatitis in the general population and guide the effective allocation of health care resources. Epidemiological studies on the prevalence of acute pancreatitis are now warranted (BOX 1).
Population-based data on the prevalence of chronic pancreatitis in the general population are scarce. In a population-based evaluation from Olmsted County, Minnesota, USA, where a prospective administrative database was interrogated to identify the cases followed by a formal review of records, the prevalence of chronic pancreatitis in 2006 was 42 per 100,000 persons16. The prevalence was highest in the 45–74 years of age group, and in men when compared with women (52 versus 34 per 100,000 persons). Based on a nationwide survey, the estimated prevalence in the Japanese population in 2011 was similar (52 per 100,000 persons)17. The lack of data on the burden of chronic pancreatitis in most populations of the world makes this an important area for future research to better understand the similarities and differences between populations (BOX 1).
The pooled mortality from an episode of acute pancreatitis in seven population-based cohort studies evaluated in the systematic review by Xiao et al. was 1.16 (95% Cl 0.85–1.58) per 100,000 general population per year9. Although subgroup analyses and meta-regression was not feasible in the systematic review, determinants for increased risk for mortality in acute pancreatitis are well-established and include persistent organ failure and infected pancreatic necrosis18–20. Importantly, although there has been a general trend towards decreasing case-fatality of acute pancreatitis, the population mortality from acute pancreatitis remains the same21,22.
Case-fatality from recurrent acute pancreatitis (typically <1% in modern studies) is lower than from the first attack (typically <10% in modern studies). It is possible that parenchymal damage from a prior attack affects the ability of the pancreas to mount a similar inflammatory response23. In a 2006 systematic review of population-based studies, nine out of 10 studies reported lower case-fatality in patients who suffered from a recurrent attack than those suffering the first attack22.
Xiao et al. found that the crude mortality from chronic pancreatitis was 0.09 (95% Cl 0.02–0.47) per 100,000 person-years9. In the majority of patients with chronic pancreatitis, deaths are attributed to non-pancreatitis causes — most frequently, cancers and cardiovascular diseases. Pancreatitis is attributed as a potential cause in <25% deaths16,24.
Sequelae of pancreatitis
Post-pancreatitis diabetes mellitus.
Metabolic abnormalities are an important and frequent sequelae of pancreatitis. Diabetes of the exocrine pancreas (DEP) and its 3 subtypes — post-pancreatitis diabetes mellitus (PPDM), pancreatic cancer-related diabetes (PCRD) and cystic fibrosis-related diabetes (CFRD) — have been suggested as a uniform nomenclature25. The rationale, definitions and exclusions for these subtypes are presented in detail elsewhere25. Importantly, not every case of hyper-glycaemia in the context of acute or chronic pancreatitis should be regarded as PPDM26. Furthermore, PPDM and other types of diabetes cannot coexist even though some elements of the pathogenesis can overlap (for example, insulin resistance in both type 2 diabetes and PPDM). This aspect is in line with the American Diabetes Association classification of diabetes, which recognizes that all types of diabetes possess unique aetiologies, but not necessarily elements of pathogenesis. In that regard, PPDM should be afforded the same considerations as gestational diabetes and post-transplantation diabetes mellitus, which are both integral parts of the American Diabetes Association diabetes classification25,27. A proposed algorithm to diagnose PPDM is presented in . Specific markers for PPDM (and DEP in general) will probably be discovered in the future (BOX 1).
Diagnostic algorithm to identify individuals with PPDM.
Post-pancreatitis diabetes mellitus (PPDM) should be suspected in all adults with a history of pancreatitis who meet the diagnostic criteria for diabetes by the American Diabetes Association. Confirmed type 1 diabetes, or type 2 diabetes prior to first attack of pancreatitis, or stress hyperglycaemia during (or within 3 months after) pancreatitis rules out the diagnosis of PPDM. The 3-month threshold is applied because glycated haemoglobin (HbAlc) level reflects average plasma glucose over the previous 8–12 weeks. The term ‘New-onset diabetes after pancreatitis’ (NODAP) is reserved for individuals with PPDM who had documented normal glucose homeostasis at baseline (as evidenced by available HbAlc and/or fasting plasma glucose (FPG) data). The algorithm has been devised by the authors. The glycated haemoglobin HbAlc test should be performed using a method that is certified by the National Glycohaemoglobin Standardization Program (NGSP) and standardized or traceable to the Diabetes Control and Complications Trial (DCCT) reference assay. Fasting is defined as no caloric intake for at least 8 h. Autoimmune markers include islet cell autoantibodies and autoantibodies to glutamic acid decarboxylase, insulin, the tyrosine phosphatases IA-2 and IA-2b and zinc transporter antigen. The oral glucose tolerance test can also be used to diagnose diabetes, if it is deemed practical and time-efficient in a given hospital.
The pathogenesis of post-chronic pancreatitis diabetes mellitus (PPDM-C) is quite straightforward — worsening insulin deficiency is induced by progressive fibrosis of the exocrine tissue and a persistent pro-inflammatory milieu. As such, the frequency of this condition is generally a function of duration of chronic pancreatitis28. For example, a single-center follow-up study of 445 patients with chronic pancreatitis conducted in China showed that the frequency of diabetes at the onset of chronic pancreatitis was 3.6%; at 1 year after diagnosis of chronic pancreatitis, the frequency was 7.5%, and at 10 years and 20 years after diagnosis it was 28% and 52%, respectively29. A similar time-dependent increase was reported in a study of 656 patients with chronic pancreatitis conducted in Japan, in which the frequency of diabetes at the onset of chronic pancreatitis was 10%. At 10 years after chronic pancreatitis diagnosis the frequency of diabetes was 50%, and after 25 years it was 83%30.
Although historically the majority of evidence related to PPDM was in the context of chronic pancreatitis, a 2014 systematic review by Das et al. assessed post-acute pancreatitis diabetes mellitus (PPDM-A)31. This study pooled data from prospective clinical studies of 1,102 patients with a first attack of acute pancreatitis who had been followed up for newly developed abnormalities of blood glucose metabolism. Importantly, the study excluded patients who had previous history of diabetes or prediabetes, cohorts limited to patients who underwent pancreatic surgery, and cohorts limited to patients with chronic, autoimmune or hereditary pancreatitis. The study made three main inferences. First, frequency of PPDM-A in individuals after a single episode of acute pancreatitis is markedly higher than in the general population without history of acute pancreatitis. Second, the frequency of PPDM-A is not substantially affected by the severity of acute pancreatitis and, hence, its burden is non-negligible as patients with non-necrotizing pancreatitis (who constitute the majority of patients with acute pancreatitis) are also at a high risk of developing PPDM. Third, a considerable fraction of individuals with PPDM-A receive insulin therapy and, contrary to earlier beliefs, elevated levels of fasting plasma glucose are not transient and not inconsequential. These inferences were subsequently confirmed in several larger scale high-quality population-based studies that compared the risk of developing diabetes in people after first episode of acute pancreatitis and in general population using complementary epidemiological approaches, all adjusting for key covariates.
The study by Shen et al. included 2,966 individuals after acute pancreatitis and 11,864 control individuals from the general population matched for age and sex (who had no prior diagnosis of diabetes or disease of the exocrine pancreas)15. This study showed that the adjusted risk of PPDM was 2.54 (95% Cl 2.13–3.04) times higher among those who had an attack of acute pancreatitis than those who had not. Another study by Lee et al., which included a total of 3,187 individuals who had had acute pancreatitis and 709,259 randomly selected control individuals from the general population (who had no prior diagnosis of diabetes or acute pancreatitis), found that the adjusted risk ofPPDM was 2.1 (95% Cl 1.92–2.41) times higher among those who had an episode of acute pancreatitis14. Furthermore, the results of the two population-based studies conducted in Taiwan corroborate the findings of the earlier meta-analysis by Das et al. that included a total of 24 prospective follow-up studies from around the world31. Taken together, these data indicate that individuals with a history of acute pancreatitis are a high-risk group for the development of diabetes, with the risk being at least 2 times higher than in individuals in the general population who do not have a history of acute pancreatitis.
The two studies mentioned above also confirmed that the high-risk of PPDM-A is not limited to patients with non-mild acute pancreatitis. Specifically, Shen et al. showed that using a sensitivity analysis constrained to individuals with mild acute pancreatitis only (81.4% of all cases in their study) yields a 2.49 (95% Cl 2.04–3.04) times higher risk of new-onset diabetes in comparison with the general population15. Lee et al. used a complementary approach and constrained their sensitivity analysis to individuals with non-mild acute pancreatitis only (8.7% of all cases in their study). Individuals with non-mild acute pancreatitis had a 2.22 (95% Cl 1.50–3.29) times higher risk of new-onset diabetes than individuals in the general population14. Taken together, these data suggest that, contrary to common belief, mechanical destruction of the islets of Langerhans as a result of pancreatic necrosis (with or without surgery) is not the only cause of PPDM-A. The pathogenesis of PPDM-A is being actively investigated, with the key mechanisms identified thus far being persistent low-grade inflammation32–34, dysfunction of the pancreas-gut-brain axis35–37, lipolysis of adipose tissue38–40 and insulin resistance41–43.
High frequency of insulin therapy in individuals with a history of pancreatitis was confirmed in a 2017 study by Woodmansey et al.44. The authors searched a large database of patients (n = 2,360,631) in the UK who had been registered at primary care practices and identified 31,789 new-diagnoses of adult-onset diabetes, of which 502 cases were DEP (including 361 cases of PPDM-A). At 1 year after diagnosis of diabetes, 1.4% (95% Cl 1.3–1.6) of individuals with type 2 diabetes required insulin compared with 9.7% (95% Cl 6.8–13.7) of individuals with PPDM-A and 16.3% (95% Cl 13.1–20.0) of individuals with DEP overall. At 5 years after diagnosis, 4.1% (95% Cl 3.8–4.4) of those with type 2 diabetes required insulin compared with 20.9% (95% Cl 14.6%−28.9%) of individuals with PPDM-A and 29.6% (95% Cl 23.6–36.4) of individuals with DEP overall. Owing to more frequent administration of insulin therapy, individuals with PPDM might need closer monitoring than individuals with type 2 diabetes. The absence of a management protocol specifically tailored to individuals with PPDM is a substantial clinical practice gap (BOX 1).
Two large population-based studies in tertiary care and primary care settings have used complementary approaches to determine the incidence of DEP and the frequency of its subtypes. The study by Pendharkar et al.10 identified cases of new diagnoses of diseases of the exocrine pancreas and DEP (as well as its subtypes) among nearly 3 million residents of New Zealand, whereas the study by Woodmansey et al.44 (described earlier) identified cases of new diagnoses of adult-onset diabetes and DEP (as well as its subtypes) among more than 2 million UK residents. The incidence of DEP in the primary care setting in the UK was 2.59 (95% Cl 2.38–2.81) per 100,000 general population per year44 whereas its incidence in the tertiary care setting in New Zealand was 10.00 (95% Cl 9.66–10.34) per 100,000 general population per year11. Until population-based studies from other parts of the world are completed, it is reasonable to assume that the incidence of DEP worldwide is ~6 per 100,000 general population per year. The new epidemiological data derived from these studies indicate that DEP constitutes 1.6% of all cases of diabetes in adults (which makes it the second most common type of adult-onset diabetes), four out of five patients (80%) develop DEP after pancreatitis (with PCRD contributing 18% and CFRD contributing 2% to DEP frequency), and the contribution of acute pancreatitis to PPDM risk is considerably larger (83% versus 17%) than that of chronic pancreatitis ().
Epidemiology of diabetes of the exocrine pancreas.
a | Frequency of diabetes of the exocrine pancreas in adults, b I Frequency of subtypes of diabetes of the exocrine pancreas, c | Frequency of subtypes of post-pancreatitis diabetes mellitus. Data are derived from the pooled estimates reported by Woodmansey et al.44 and Pendharkar et al.10–11. Post-acute pancreatitis diabetes mellitus includes cases with diabetes after both first acute pancreatitis episode and recurrent acute pancreatitis.
Exocrine pancreatic dysfunction.
Similar to endocrine dysfunction, abnormalities in pancreatic exocrine function were initially considered only in the context of chronic pancreatitis. In classic natural history studies, up to 80% patients develop EPI during the course of disease45–47. The probability increases with disease duration, reflecting progressive destruction of the pancreatic parenchyma from inflammatory and fibrotic changes. In physiological studies, clinical signs of EPI (the main sign of which is steatorrhoea) are expected with ~90% loss of pancreatic exocrine tissue48,49.
Exocrine dysfunction after acute pancreatitis is typically associated with the extent of pancreatic damage (that is, pancreatic necrosis). A systematic review evaluated the coexistence of EPI and PPDM after acute pancreatitis50. This review included eight studies comprising 234 patients that evaluated both exocrine and endocrine functions of the pancreas, with a follow-up at the time of assessment of 12–179 months. EPI was determined in a variety of ways, including direct pancreatic function testing, measurement of faecal elastase or faecal fat levels and need for oral pancreatic enzyme replacement therapy. In seven of the eight studies, all patients had either severe or necrotizing pancreatitis, with a varying fraction having had a necrosectomy as part of treatment of their disease. The prevalence of EPI after acute pancreatitis was 29% and nearly 40% of individuals with PPDM also had concomitant EPI. Interestingly, the prevalence of EPI among patients with diabetes mellitus decreased over time.
In an earlier study, pancreatic function was assessed by two methods in 75 patients at least 4 months after an episode of acute pancreatitis. In 18 patients (8 with alcohol-related pancreatitis and 10 with biliary pancreatitis), duodenal aspiration for 30 minutes was used to evaluate lipase, chymotrypsin and bicarbonate output following intravenous infusion of secretin and the oligopeptide cerulein. In 57 patients (28 with alcohol-related pancreatitis and 29 with biliary pancreatitis), the assessment was made using plasma amino acid levels taken at different intervals before and after a one hour infusion of cerulein (known as the amino acid consumption test)51. In 46 of the 57 patients who underwent the amino acid consumption test, the test was repeated after 1 year. The authors found that pancreatic function was decreased in 85% patients with alcoholic acute pancreatitis irrespective of severity, whereas in those with biliary pancreatitis it was affected only in patients with necrotizing pancreatitis but at a much lower frequency (22%). Upon repeat testing a year later, patients with alcohol-related pancreatitis and those with necrotizing pancreatitis showed continued abnormality, whereas the only patient with mild biliary pancreatitis and borderline exocrine dysfunction of the pancreas showed improvement. These data suggest that clinically relevant EPI is relatively common after acute necrotizing pancreatitis, and more frequent in patients with alcohol-induced disease. In contrast to endocrine dysfunction, the risk of which progressively increases over time, loss of exocrine function after acute pancreatitis seems to be steady. A limitation of published data is the lack of uniform criteria to define exocrine function. Thus, modern, adequately powered clinical studies in patients with varying severity using uniform definitions are needed to investigate the prevalence and factors associated with exocrine dysfunction after acute pancreatitis.
The importance of bone health in chronic pancreatitis is gaining attention. In a systematic review of 10 studies comprising 513 patients with chronic pancreatitis, the prevalence of osteoporosis was 23.4% and 65% for osteoporosis or osteopenia52. Owing to the small sample sizes of primary studies, stratified analyses were not possible, although it seemed that the rates were not influenced by age, sex and geographic region. Risk of fractures, the clinical consequence of low bone density, was assessed in three large cohorts. In a tertiary care center study of 3,192 patients with chronic pancreatitis conducted in the USA, the prevalence of low fragility fractures in those with chronic pancreatitis was higher than in control individuals who did not carry a diagnosis of chronic pancreatitis, coeliac disease, Crohn’s disease, cirrhosis or post-gastrectomy state (4.8% versus 1.1%). The odds of a fracture in patients with chronic pancreatitis were 2.4 fold higher than control individuals after adjusting for age, sex and race, and were similar to other gastrointestinal conditions with well-recognized increased risk of osteoporosis and fractures (mentioned earlier)53. In a study of 453,912 veterans in the USA, of whom 3,257 had chronic pancreatitis, the prevalence of any fracture (vertebrae, hip and wrist) in patients with chronic pancreatitis was 4.7% versus 2.07% in control individuals, and the odds of having a fracture in patients with pancreatitis were 1.7-fold greater after adjusting for age, sex, race and aetiology54. A large population-based study of 11,972 patients with chronic pancreatitis from Denmark, of which 33% were women, identified bone fractures in 2,594 (21.7%) patients55. Furthermore, the adjusted hazard ratio for any fracture was 1.7 (95% Cl, 1.6–1.8) in patients with chronic pancreatitis compared with control individuals matched for age and sex. The high frequency of osteoporosis, osteopenia and fractures warrants appropriate and timely screening of patients with pancreatitis. Similar to other gastrointestinal diseases, a European guideline published in 2017 suggested that patients with chronic pancreatitis with a history of low trauma fractures, those with malabsorption, postmenopausal women, and men >50 years of age should undergo bone density testing by dual X-ray absorptiometry56.
EPI can lead to maldigestion and malabsorption, and five of nine studies in the systematic review noted an association between pancreatic enzyme insufficiency and osteoporosis52. One consequence of malabsorption is deficiency of vitamin D, which has an important role in bone health. Interestingly, in a systematic review of nine studies, although the prevalence of vitamin D deficiency in patients with chronic pancreatitis was relatively high, it was not statistically significantly different from the prevalence in control individuals57. Also, the population-based study from Denmark mentioned earlier55 found, somewhat expectedly, that patients with chronic pancreatitis receiving pancreatic enzyme supplementation for fat malabsorption had a 20% lower risk of fractures than other patients with chronic pancreatitis. However, what was unexpected is that increased duration of pancreatic enzyme supplementation was associated with an increased risk of fracture, perhaps because of the effect of an unknown confounding factor. These findings highlight the need for well-designed physiological studies to investigate the intricate relationship between pancreatic function and bone metabolism (BOX 1).
Similar to diabetes mellitus and EPI, osteoporosis was initially deemed to not be a sequelae of acute pancreatitis. However, a population-based study of 4,016 patients from Taiwan with acute pancreatitis, published in 2017, found a statistically significant increase in incident diagnosis of osteoporosis in patients with acute pancreatitis when compared with propensity-matched control individuals, with an adjusted hazard ratio of 1.27 (95% Cl 1.02–1.58)58. The adjusted hazard ratio was even higher in patients who had recurrent acute pancreatitis attacks (4.8-fold higher in patients with more than 3 attacks), suggesting that the increased risk is, at least in part, driven by disease progression towards chronic pancreatitis. If these results are confirmed in subsequent population-based studies, investigations of the pathological mechanisms that lead to osteoporosis following acute pancreatitis will be warranted.
Holistic prevention of pancreatitis
The epidemiological burden of pancreatitis and its sequelae underscores the need for a comprehensive approach to its prevention. Prevention approaches are classically categorized as primary, secondary and tertiary in terms of the intervention time point and target population. In primary prevention, intervention is applied to the general population who do not have a disease of interest. These strategies typically aim to reduce disease incidence. Secondary prevention involves early identification of individuals with an existing disease of interest. The purpose of secondary prevention is to apply effective intervention early and reduce morbidity. Tertiary prevention is applied after a disease of interest is established, aiming at minimizing its sequelae and resulting burden59,60.
The concept of multi-level prevention has been known since the 1980s and has proven to be useful in reducing the burden of several diseases (for example, cardiovascular diseases, tuberculosis and asthma)61–63. However, the opportunity to apply this concept holisti-cally to diseases of the pancreas has been overlooked as most early research in pancreatology was focused on a single aspect of prevention — reducing the number of recurrences of pancreatitis. By aetiology, the preventive interventions included cholecystectomy for biliary pancreatitis64, alcohol counselling (for example, using structured 30-minute talks at outpatient clinics every 6 months) for alcohol-induced pancreatitis65 and tight control of lipidaemia for hypertriglyceridaemia-induced pancreatitis66. Here, we propose the holistic prevention of pancreatitis (HPP) framework, which is based on the above core principles of prevention applied, for the first time, broadly and holistically to pancreatitis. As shown in , each prevention level has its corresponding main target population: the general population for primary prevention, patients in the early stage of acute pancreatitis and chronic pancreatitis for secondary prevention, and patients with any form of pancreatitis who are at risk of sequelae (such as PPDM or EPI) for tertiary prevention.
The holistic prevention of pancreatitis framework.
Primary, secondary and tertiary levels of prevention applied holistically to acute, recurrent acute and chronic pancreatitis and as a disease continuum. EPI, exocrine pancreatic insufficiency; PPDM, post-pancreatitis diabetes mellitus.
Opportunities for multi-level prevention are available for all elements of the HPP framework. Implementation of HPP requires the concerted contributions of health care professionals from various disciplines, including primary care physicians, gastroenterologists, surgeons, radiologists, pain specialists, endocrinologists, dietitians and public health specialists. Details of the prevention strategies, intervention objectives and responsible health care sectors are outlined in . The following sections are focused on examples of emerging advances in pancreatology as they are applied to primary, secondary and tertiary prevention of pancreatitis.
Table 1 |
prevention levels and targets applied to pancreatitis
|primary prevention||Secondary prevention||Tertiary prevention|
|First acute pancreatitis episode|
|Prevention strategies||• Education of general population
• Avoidance of high-risk medications and futile ERCP
|• Effective algorithms for early identification and effective in-hospital management of AP||• Screening of patients at high risk|
|Intervention objectives||• Reducing heavy alcohol use, smoking and obesity
• Increasing intake of vegetables
• Judicious use of drugs known to induce AP
• Restricted use of ERCP
|• Early detection of AP and removal of known aetiologies (for example, cholecystectomy, control triglycerides, discontinuation of drugs that induced AP, alcohol, smoking)
• Judicious use of opiates, nutrition and fluids to prevent progression of AP severity
|• Early detection and management of sequelae (for example, PPDM, EPI) via regular follow-ups
• Administration of preventative medications (for example, metformin for PPDM)a
|Responsible sector||• Public health specialists
• Primary care physicians
|• Primary care physicians
|• Primary care physicians
|Recurrent acute pancreatitis|
|Prevention strategies||• Education of general population and individuals with prior attack of AP||• Effective in-hospital management of AP||• Screening of high-risk patients|
|Intervention objectives||• Reducing heavy alcohol use, smoking and obesity
• Increasing intake of vegetables
• Judicious use of drugs known to induce AP
• Avoidance of futile ERCP
• Administration of preventative medications (for example, statins)a
|• Removal of known aetiologies (for example, cholecystectomy, control triglycerides, discontinuation of drugs that induced AP, alcohol, smoking)
• Judicious use of opiates, nutrition and fluids to prevent progression of AP severity
|• Early detection and management of sequelae (for example, PPDM, EPI) via regular follow-ups
• Administration of preventative medications (for example, metformin for PPDM)a
|Responsible sector||• Public health specialists
• Primary care physicians
|• Primary care physicians
|Prevention strategies||• Education of general population and individuals with prior attack of AP||• Effective algorithms of early identification of CP||• Screening of high-risk patients
• Professional health consultancy for patients with CP
• Chronic pain management
|Intervention objectives||• Reducing heavy alcohol use, smoking and obesity
• Increasing intake of vegetables
• Administration of preventive medications (for example, statins)a
|• Early detection of CP
• Removal of known aetiologies (for example, alcohol, smoking)
• Treatment of pancreatic strictures and stones
• Discontinuation of alcohol and smoking
|• Early detection and management of sequelae (for example, PPDM, EPI) via regular follow-ups
• Patient behaviour change
• Administration of preventative medications (for example, calcium and vitamin D for osteoporosis, metformin for PPDMa)
|Responsible sector||• Public health specialists
• Primary care physicians
|• Primary care physicians
|• Primary care physicians
• Pain specialists
A comprehensive systematic review of general population-based studies evaluated more than 30 factors associated with diseases of the exocrine pancreas8. This study estimated that more than half of pancreatitis cases could have been prevented if all people in the general population were non-smokers, nearly one-fourth of cases if all individuals in the general population were a normal weight (BMI 18–25 kg/m2), and nearly one-fifth of cases if they had limited alcohol consumption. The review also emphasized that consumption of vegetables and fruits is associated with a nearly 30% reduced risk of all diseases of the exocrine pancreas8. Specifically, vegetable consumption was associated with a statistically significantly reduced risk of acute pancreatitis (OR 0.64, 95% Cl 0.50–0.82)8. The open question is how best to use these data on primary prevention of pancreatitis at population level as associations between diet, obesity, smoking, alcohol and risk of other major diseases of the pancreas (pancreatic cancer) are well known67,68, but these findings have not yet been translated into actionable steps.
The form of acute pancreatitis particularly amenable to primary prevention by gastroenterologists is pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). Avoidance of futile ERCP and the appropriate choice of sedation for ERCP69,70, rectal administration of nonsteroidal anti-inflammatory drugs71,72 and optimization of cannulation technique in patients at high-risk (for example, in those with clinical suspicion of sphincter of Oddi dysfunction, pancreatic sphincterotomy, precut sphincterotomy or ampullec-tomy)73 have proven to be beneficial. Pharmacological interventions (statins in particular) are being trialled as a means of primary prevention of recurrent acute pancreatitis74 and results are eagerly awaited ().
The emerging aspect of secondary prevention of acute pancreatitis is epitomized in the concept of gut rousing’, which has replaced the pancreas rest’ concept that dominated the field in the 20th century75. The new concept has been developed to prevent progression of acute pancreatitis severity by optimizing the use of the three mainstays of early management — opiates, fluids and nutrition76. The concept postulates that the presence of gut dysfunction worsens the outcomes of patients with acute pancreatitis, and the key factors that affect gut function are both pathogenic and iatrogenic (specifically, liberal administration of opiates and fluids)77. The concept also recognizes that in acute pancreatitis the gastrointestinal tract should be afforded the same considerations as the other vital systems (respiratory, cardiovascular and renal), and it should be targeted by appropriate therapies. In particular, timely administration of apposite feed into the lumen stimulates (rouses) the gut, mitigates gut dysfunction and restores normal gut function. Neglecting the gut (for example by resting the pancreas) or administering feed at a wrong time leads to worsen outcomes78.
An emerging example of secondary prevention of chronic pancreatitis is the identification of biomarker signatures that can accurately detect early stage disease79. These signatures will not only uncover the specific pathogenic bases of chronic pancreatitis but will also enable tailored selection of patients for future clinical studies, including but not limited to those investigating anti-inflammatory and anti-fibrotic drugs (BOX 1). In that regard, a draft proposal has offered a new mechanistic definition of chronic pancreatitis as: “a pathologic fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental and/or other risk factors who develop persistent pathologic responses to parenchymal injury or stress”80. This definition holds promise as it might enable a platform for future research to understand markers of different stages of the disease.
Although time from an episode of pancreatitis to developing its sequelae varies in the published studies, there is clearly a large window of opportunity for their prevention. For example, two large studies investigated factors associated with PPDM. A study by Ho et al.81 included a total of 12,284 patients with first attack acute pancreatitis. Alcohol-related acute pancreatitis, more recurrences of acute pancreatitis, male sex and age ≥ 65 years were associated with diabetes after acute pancreatitis in multivariable analyses. Conversely, severity of acute pancreatitis, Charlson comorbidity score and monthly income were not associated with diabetes after acute pancreatitis81. A multi-centre study by Beilin et al.82 included a total of 1,171 patients with chronic pancreatitis. Overweight or obesity, EPI, pancreatic calcifications, prior pancreas surgery, family history of diabetes, male sex, age and duration of pancreatitis were associated with the presence of diabetes in patients with chronic pancreatitis in multivariable analyses, whereas heavy alcohol intake and smoking were not associated with the presence of diabetes. However, the studies by Ho et al.81 and Beilin et al.82 did not investigate the relative weights of risk factors. This aspect was addressed in the derivation of the Prediabetes self-assEssment scReening Score aftEr acUte pancreatitis (PERSEUS)83, which is the first screening instrument to identify patients after an episode of acute pancreatitis who are at high risk of developing prediabetes (and ultimately diabetes). The score is intended for use by patients after hospital discharge to self-assess their probability of having impaired glucose homeostasis. Development of the score began with a comprehensive review of published screening scores for type 2 diabetes and prediabetes, which identified four main domains — anthropometric data, sociodemographic factors, lifestyle-related factors and personal and family health history84. PERSEUS was then developed and validated in two independent cohorts, resulting in area under the receiver operating characteristic of 0.88 and 0.81 in the training and validation cohorts, respectively83. Importantly, all variables included in the score are readily available to individuals and do not require laboratory testing. Two variables — tobacco smoking and abdominal adiposity — are modifiable risk factors that are worth targeting with a view to reducing the incidence of PPDM.
Natural Pancreatitis Treatment With Vitamins, Herbs and Supplements
Commonly available dietary supplements may treat pancreatitis.
Your pancreas is an organ and gland that is located in your upper abdomen, near your stomach. The pancreas releases two important hormones, insulin and glucagon, as well as enzymes that help you break down and process food. Pancreatitis is an inflammation of the pancreas that may be short-lived or chronic. Vitamins, herbs and other dietary supplements may help treat pancreatitis. However, discuss the possible risks and benefits of supplementation with your doctor before using these substances.
Pancreatitis and Health
The most common symptom caused by pancreatitis is abdominal pain that is often extreme. If you have acute pancreatitis, your pancreas quickly becomes inflamed, although the inflammation is usually resolved within several days. If you have chronic pancreatitis, however, pancreas inflammation may last for prolonged periods, even years, which can cause irreversible damage in this organ. In some cases, chronic pancreatitis may manifest after repeated bouts of acute pancreatitis.
Herbs, Vitamins and Supplements
Certified nutritional consultant Phyllis Balch, author of “Prescription for Nutritional Healing,” notes that there are many vitamins, herbs and supplements that may help treat pancreatitis. Vitamins B3 and B5 are important for fat and carbohydrate metabolism; vitamin C is a powerful antioxidant; and vitamin E is important in tissue repair. Helpful herbs for this condition include milk thistle, red clover, burdock root, dandelion root, olive leaf, garlic and licorice. Important non-herbal supplements for the treatment of pancreatitis include chromium picolinate, calcium and magnesium and pancreatin.
Dandelion root is an herbal supplement that is commonly used to help treat pancreatitis. Balch notes that dandelion root helps stimulate and strengthen your pancreas and may improve the function of other organs, too, including the kidneys, spleen and stomach. The root of the dandelion plant contains many phytochemicals and nutrients and is the part of the plant most often used in herbal preparations, although the leaves and flowers may also be used. Dandelion may help cleanse the blood and liver and increase bile production.
Vitamins, herbs and other dietary supplements should only be used in treating pancreatitis after you have discussed the health benefits and risks with your family physician. A qualified health care professional can evaluate your condition and make other relevant treatment suggestions that may be more appropriate for you. Some dietary supplements may cause unintentional side effects or drug interactions that may be dangerous. Ask your doctor about proper dosage, treatment duration and other herb-related topics.
Helping a Dog with Pancreatitis: the Natural Way – Extreme Electric Dog Fence 2021 DIY
If your dog has pancreatitis, you likely have an understanding of the seriousness of this condition. As with many things in life, prevention is key. Before we explore the topic of pancreatic disease, let’s talk about how miraculous this organ truly is. Think about this. The pancreas is relatively small organ. This little but vital organ works to keep dogs alive by assisting in digestion. It also produces insulin, which transforms energy from food and delivers it to all of the cells in the body. Without the pancreas, a dog wouldn’t be able to survive. This gland forms part of the digestive system. It has a dual function of secreting enzymes and produces hormones. Happiness and enthusiasm of life can be found by pondering the miracles found in nature.
What Is Pancreatitis, Anyway?
Quite simply, it is inflammation of the pancreas. When viewed holistically, several factors may be the cause of this condition. However, research does show that pancreatitis is much more common among dogs that eat kibble. Compared to other mammals, the digestive tract of dogs is much shorter. This means that while they are able to digest meat, organs, bones and some plant material with ease, digestion of starches becomes more difficult. Experts agree that eating heavily processed grains is not what Mother Nature intended for dogs. Any type of processed food causes the pancreas to become stressed. When the pancreas becomes overwhelmed, inflammation can occur.
When the pancreas becomes inflamed, its digestive enzymes activate prematurely. This can trigger the pancreas to “digest itself”, causing it to become even more irritated. At this point, these enzymes from the pancreas may leak into the abdomen, which can cause damage in this area and cause problems to the kidney and liver. Pancreatitis is something that needs to be taken seriously, as it can threaten your dog’s life.
About Acute Pancreatitis
When pancreatitis is labeled as acute, this means it is the most serious form of the disease. It has the ability to develop very suddenly. Recognizing the symptoms of acute pancreatitis is crucial. Your dog may lose his appetite, may be vomiting, and at times diarrhea may be occurring. Lethargy and dehydration are other common symptoms. The dog’s abdomen may seem harder than normal and sensitive to the touch. This is because the pancreas can be found close to the stomach and is near the abdomen.
With chronic pancreatitis, there may not be any symptoms. On occasion you could see slight cases of vomiting or diarrhea. With this, a slightly elevated pancreatic enzyme level could be found.
A blood test is needed to confirm a diagnosis of pancreatitis. A chemistry panel as well as a CBC should be conducted, as well as the testing of lipase levels. There is a relatively new test for pancreatitis available, called a canine pancreas specific lipase test. In addition to this, X-rays or an ultrasound exam may be needed to confirm the diagnosis, as there could be other reasons why the dog could be experiencing symptoms similar to those caused by pancreatitis.
Options for Treating Pancreatitis Naturally
According to Dr. Peter Dobias, a licensed doctor of veterinary medicine, here are some tips to help your dog heal from pancreatitis naturally.
- Try switching your dog to a diet that is designed for their specific species. He says that processed food doesn’t fall into this category.
- Dobias recommends putting energy into feeding your dog a wholesome, natural diet of raw food.
- Try to cleanse, nourish and detox the dog’s body with a whole food supplement, known as sea greens.
- Try giving your dog a certified organic, whole food multivitamin that is of high quality.
- Essential fatty acids may be very helpful for your dog. Look for sources that contain salmon, krill and flax seed oil. He does not recommend any of the other fish oils as they may contain dangerous mercury and strontium.
- Giving your dog probiotics may help to create a balance in their immune system, boost their intestinal flora and keep diarrhea from happening.
- He suggests adding a glandular supplement. Specifically, he recommends a product known as Standard Process Pancreatrophin PM, which is designed to nourish and protect the pancreas.
- If possible, take your dog to the chiropractor. This may help with the muscle tightness that develops when a dog has pancreatitis. A physiotherapist, osteopath or massage therapist may also be beneficial to him or her. Dr. Dobias recommends starting out going every other week, and then change to monthly when appropriate.
Pancreatitis Treatment Options for Dogs and Cats
Pancreatitis Holistic Protocol for Dogs and Cats has been developed by a certified Master Herbalist and certified Canine Nutritionist with The Pet Health and Nutrition Center. Our Pancreatitis Protocol is the finest coordination of science and research-based recommendations that include diet, supplementation and herbal remedies to help support your dog or cat with pancreatitis. Everyone here at The Pet Health and Nutrition Center truly cares and wants to help your pet get better, so give our suggestions a try because we are confident you will be pleased with the results.
1. What Is Pancreatitis?
Pancreatitis is quite simply inflammation of the pancreas. This condition is most commonly seen in middle aged to older dogs that have been fed a kibble pet food that is hard on the pancreas for a number of different reasons. These dogs typically become over-weight from this processed food diet and the added treats and lack of proper exercise that are to common in our domesticated animals.
Onset of pancreatitis can progress over time (chronic) or occur quickly (acute) which can be quite serious. Any symptoms displayed after meals, such as abdominal discomfort or restlessness, that may be displayed by the dog standing in a “prayer position” by stretching the body out to decrease pressure on the abdomen or similar action, should be paid close attention to and not ignored. These initial warning signs can progress to fever, loss of appetite, severe vomiting and diarrhea that may be yellow and “greasy” which can indicate a serious phase of the condition and should be treated quickly by your veterinarian.
2. Causes of Pancreatitis
Symptoms of pancreatitis often display after the ingestion of a high-fat meal. However, it is not the high-fat meal that caused the pancreatitis, but the extra digestive load placed on a sick organ. So when we discuss what caused your animal’s pancreatitis, what we should really be looking at is what caused the damage to the pancreas in the first place.
The pancreas is an easily damaged, delicate organ that is slow to heal. It can be injured by a poor diet, excessive weight, and the over-use of drugs like corticosteroids, antibiotics and diuretics. In addition, underlying conditions that involve the liver, gallbladder, kidneys or cardiovascular system can place stress on this organ that lead to its decline over time. This is why you will see the support of the aforementioned organs as part of our holistic protocol.
3. Standard Veterinary Medicine Approach
Your veterinarian will most likely conduct a physical exam and then do blood tests to check pancreatic enzyme levels. They may also choose to perform x-rays or ultrasound tests to see if there is any noticeable inflammation of the pancreas. Initial treatment focuses on managing/relieving pain, controlling nausea and establishing proper fluid and electrolyte balances. This course of action will require an assortment of pharmaceutical drugs with a variety of side-effects to worry about. In the case of a life-threatening, acute occurrence medications may be necessary in the short-term. Sometimes, pancreatitis may be misdiagnosed as just stomach upset and a medication to manage this may be recommended. Once pancreatic inflammation has calmed down, a low-fat, low-protein prescription diet is usually recommended by the veterinarian.
4. Holistic Pancreatitis Protocol for Dogs and Cats
The goal of our Natural Pancreatitis Protocol is to support the pancreas by providing digestive enzymes to enhance proper digestion while also increasing the proper secretion of bile from the liver and gallbladder to efficiently begin the breakdown of fats.* Organic, whole-food supplementation will also provide nutrients to support the healing of the pancreas itself.*
Initially, meals should consist of smaller portions and spread out to three or four times per day to ease the burden on the stressed pancreas. Excessive fat and other foods that are noticed to contribute to digestive upset should be eliminated. The diet should be whole food and easily digestible which would point to home-preparing as the best choice to make sure that the pet parent has control over added ingredients.
Core Recommendations Suggested products are included in the Core Pancreatitis Package found below.
Our “Core Recommendations” form the backbone of our Natural Pancreatitis Protocol. They consist of supplement recommendations that we feel are the most important to provide to your animal companion for this condition. They are displayed as a package and individually at the bottom of this page along with other helpful products from which you may make additional selections. Pet foods can be purchased at your finer, local pet stores. If you desire more individualized attention please feel free to use our Consultation Form to provide detailed information about your dog or cat so we can better help you.
Core Recommendation #1 – Daily Multi Plus
Our Daily Multi Plus is formulated with organic, whole foods that are extremely important to an animal’s nutritional needs but are often missing from the majority of canine and feline diets. This special formula provides the enzymes, probiotics, prebiotics, glandulars, vitamins, minerals, antioxidants and phytonutrients that are so beneficial to the body’s daily maintenance and repair needs for healthy aging. In this formula you will find the vitamins, minerals, antioxidants and especially enzymes and probiotics recommended by the veterinarian community for this condition – only in an organic, whole food form!
Core Recommendation #2 – Liver Tonic
Our Liver Tonic will help to gently detoxify and improve the function of the liver and gallbladder. This will help to reduce stress on the pancreas by improving bile production and secretion. Bile begins the process of breaking down fats (emulsify) and is produced by the liver and stored in the gallbladder. If these organs are not functioning properly, perhaps being damaged by drug therapies, the pancreas will suffer as a result.
Core Recommendation #3 – Pancreas Glandular
Research shows that nutrients from glandular tissue travels to the corresponding glands in the body. This means that when you provide a pancreas glandular supplement, pancreas specific nutrients travel to your dog or cat’s pancreas to support this particular organ. This is a very simple yet effective way to strengthen a weak pancreas.
Core Recommendation #4 – Ox Bile Powder
The bile acids found in ox bile help to break down fats to reduce stress on the pancreas. In addition, the components of ox bile help to improve liver and gallbladder function while helping to prevent the accumulation of cholesterol particles that could interfere with organ health and possibly contribute to the formation of gallstones in the future.
Whole Food Nutrition
With a condition like Pancreatitis we highly recommend a home-prepared, whole food diet that can be either cooked or raw. Feeding your dog or cat in this manner will allow you to control what is included in the diet. As mentioned earlier, at least initially meals should consist of smaller portions and spread out to three or four times per day to ease the burden on the stressed pancreas. Excessive fat and other foods that are noticed to contribute to digestive upset should be eliminated.
There are now many quality premixes to choose from to which you can add your own raw or cooked meat that make home-preparing easier. If you decide to make a homemade diet please research the proper way to do this and make sure to add a calcium source like our Seaweed Calcium. For a quick and easy way to add high-quality protein to your dog’s diet take a look at our Whey Protein Isolate. A high-quality, meat based canned food can also be a good option, especially for cats, because of canned foods’ high moisture content (be careful to choose canned foods with little to no fish content for too many reasons to list here). For more information read our articles How to Feed Your Dog or How to Feed Your Cat that can be found in our Education section.
This is a very effective formula that helps to firm stool and reduce inflammation in the digestive tract. What further separates this supplement from others is the probiotic organism it contains that has been shown in studies to replenish beneficial organisms and alleviate diarrhea more quickly.
Herbal Digestive Tonic
Many animals we see are having problems with hypochloridia, or low stomach acid output. Feeding a kibble diet raises the alkalinity of your pet’s stomach resulting in incomplete digestion, but dogs and cats can have problems properly digesting other foods as well. This contributes to many imbalances in the body like pancreatitis. Our Herbal Digestive Tonic is formulated with herbal bitters that stimulate digestive secretions to super-charge digestion lowering the workload on the pancreas.
Our clients love this formula. It works wonders to help animals with everything from stomach upset to lack of appetite. The organic herbs used are unique in their ability to eliminate gas and reduce nausea and stomach inflammation quickly.
Biopreparation Microalgae Supplement
When your dog or cat is suffering with an imbalance like pancreatitis there will be an increase in free radical production that can further damage tissue and cause premature aging and possibly other disease. We want to provide your animal with high quality antioxidants to neutralize these free radicals along with other nutrients to aid the body’s healing and rebuilding processes. This specialized blend of microalgae is able to travel directly into cells providing nutrients on a cellular level without the need for digestion! In addition, nutrients from the microalgae are able to cross the blood brain barrier and the retinal barrier for amazing effects on the brain and eyes as well as the entire body. This is truly an amazing and beneficial supplement that we recommend to all of our clients as part of a natural approach for pancreatitis in dogs and cats. Select either F2 Core (basic daily support) or F3 Forte (more concentrated) depending on which you feel is best for your dog or cat – contact us with any questions.
5. Natural Remedies for Dogs and Cats with Pancreatitis
90,000 Pancreatitis treatment – long-term process
The pancreas is involved in the process of digesting food and breaking down the fats, proteins and carbohydrates we need to live. It is a very “delicate” organ of the digestive tract of any of us.
Disruption of the pancreas can be caused by improper diet (intake of fatty, fried, spicy foods), nervous stress, alcohol intake, genetic changes and hereditary factors, etc.
Inflammation of the pancreas in violation of its work is called pancreatitis.
There are acute and chronic pancreatitis. Acute is a serious disease that leads to the destruction (destruction) of the parenchyma of the gland and requires complex medical and surgical treatment.
Chronic pancreatitis is a disease with periods of exacerbation and remission, with the gradual replacement of the pancreatic parenchyma with connective tissue.
The manifestations of chronic pancreatitis can be very different. Classically, this disease is accompanied by pain and dyspeptic syndromes, impaired production and secretion of digestive enzymes (exocrine insufficiency). The absence of enzymes (lipase, amylase, protease) leads to a violation of the breakdown of proteins, fats and carbohydrates, which are absorbed in the intestine only in a certain, “prepared” form. If this does not happen, nutrients are not absorbed, weight loss occurs, and in severe cases of hypovitaminosis.
With an exacerbation of chronic pancreatitis, pain does not always appear. The disease can be manifested by bloating and rumbling in the abdomen, nausea, and the appearance of mushy (unformed) stools from 1 to 6-7 or more times a day.
The pain occurs after eating, after 30-60 minutes, it can be of a shingles character, give to the back, it can be localized in the umbilical region or the left / right hypochondrium.
The clinical picture is very diverse, so only experienced gastroenterologists and surgeons can diagnose pancreatitis.
The mandatory standard of patient examination is:
1) laboratory tests (amylase, lipase, etc.), coprogram, elastase in feces
2) ultrasound examination of the abdominal organs
Additionally, computer and magnetic resonance imaging, RCPG are used for diagnostics.
Treatment of pancreatitis is a lengthy process that begins with adherence to the strict recommendations of a doctor on nutrition and diet.
As the acute period decreases, the diet expands, the use of irritating foods (sour, salty, sweet, fresh baked goods and crackers, fatty, smoked, fried foods, etc.) is excluded. The use of fresh dairy products is also limited. An individual diet and further recommendations on nutrition during periods of remission can only be given by a gastroenterologist (nutritionist) and a surgeon.
Drug treatment in the acute period is carried out in a round-the-clock or day hospital, infusion, antispasmodic, antisecretory therapy, enzymes are prescribed, in case of severe pain syndrome, anesthetic drugs are prescribed.
The timing of treatment depends on the individual characteristics of the patient and the severity of the condition (7-10 days), and observation by a gastroenterologist and correction of treatment is required within 1-2 months. after stopping the acute process, as well as treatment 1-2 times a year to maintain a relapse-free period.
In the comfortable, equipped with all the necessary round-the-clock and day hospitals of our clinic, each patient can receive high-quality medical care, an individual approach and the attention of the best surgeons and gastroenterologists.
Head Department of surgery, Ph.D., Turkin D.V., gastroenterologist, Ph.D. Grishina I.Yu., head. therapeutic department Darsania E.A.
90,000 what drugs and means are used in the treatment of pancreatitis?
Pancreatitis requires complex and long-term treatment. The first thing that must be strictly observed after its identification is a special diet, the main purpose of which is to facilitate the work of the pancreas. But, without a doubt, diet alone is not enough – drug therapy is also needed, which differs depending on the form of the disease.
Drug therapy for pancreatitis: the necessary pills and drugs
At its core, pancreatitis is nothing more than an inflammation of the pancreas, with two main forms being distinguished.
Acute pancreatitis is most often caused by the development of enzymatic autolysis, or self-digestion of an organ. It occurs due to damage to acinous cells, that is, those that are responsible in the body for the production of digestive enzymes, as well as due to the increased separation of pancreatic juice together with a delay in its outflow.As a result, enzymes are activated in the pancreas itself, resulting in acute pancreatitis. Damage to acinous cells can be triggered by a variety of reasons: abdominal trauma, surgery on the gastrointestinal tract, intoxication, allergic reactions, endocrine disorders, including pregnancy. But most often acute pancreatitis is caused by gross errors in nutrition, for example, excessive fatty foods, and alcohol abuse.
A companion of acute pancreatitis is always cutting and prolonged girdle pain in the upper abdomen.Sometimes the pain radiates to the region of the heart or to the sternum.
There are also primary chronic pancreatitis , in which inflammation develops directly in the pancreas itself, and secondary , which is a consequence of another disease of the digestive system – gastritis, cholecystitis, peptic ulcer, etc. Acute pancreatitis without proper treatment and prolonged preventive regimen is quite capable of becoming chronic.
Chronic pancreatitis is characterized by the presence of two successive stages: the stage of remission, in which the patient’s quality of life improves somewhat, and the stage of exacerbation, always accompanied by severe pain and requiring immediate medical intervention.
But whatever form of pancreatitis is diagnosed in a patient, in any case, there is a serious danger to his health. Since the affected pancreas ceases to cope with the task assigned to it – to digest food – to the extent that it should do it. Exocrine organ failure, which occurs as a result of pancreatitis, leads to a shortage of the necessary substances from food by the body, as a result of which anemia, a sharp decrease in weight, and vitamin deficiency can occur.
Mandatory used to alleviate the patient’s condition in acute pancreatitis or exacerbation of its chronic form. In some cases, the pain can be prolonged, persisting for a day, and extremely severe – up to loss of consciousness. Pain relievers can be administered intravenously to relieve pain, which greatly increases the rate at which they act. If the pain is severe, the doctor may prescribe blockades that relieve pain.
Antispasmodics are also prescribed to relieve pain. Under their influence, the vessels of the pancreas expand, spasms of the smooth muscles of the bile ducts and the sphincter of Oddi are relieved, due to which there is a violation of the outflow of pancreatic juice and bile into the duodenum.
Antispasmodics should not be taken for more than two days without the recommendation of the attending physician, as they can have very unpleasant side effects .
The inflammatory process in pancreatitis not only affects the pancreas itself, but also often penetrates the organs adjacent to it. In order to reduce the spread of this process, anti-inflammatory drugs and broad-spectrum antibiotics are prescribed. Taking them can reduce the risk of serious complications such as sepsis, peritonitis, abscess, and pancreatic necrosis.
The doctor may prescribe enzyme therapy to compensate for the production of enzymes by the affected organ only in chronic pancreatitis without exacerbation.Enzyme-containing preparations are included in one of two groups:
- based on pancreatin – an enzyme-containing extract of the pancreas, the active substances of which facilitate the digestion of food, eliminate nausea, and improve the patient’s well-being;
- based on bile acids , effective for digesting fats and enhancing motility. However, taking bile-based drugs is often undesirable, since bile acids provoke an overly active secretion of pancreatic juice.
Antacids are often prescribed in conjunction with enzyme-containing drugs to enhance the activity of the latter. Antacids are also taken to reduce the acidity of gastric juice, since too high a concentration of hydrochloric acid contained in it can provoke an increased activity of the pancreas.
Drugs that are completely soluble in human blood are considered to be absorbed antacids.They quickly reduce acidity, but they differ in the short duration of exposure and a whole set of side effects. Non-absorbable antacids, in turn, are divided into two groups:
- aluminum salts of phosphoric acid;
- aluminum-magnesium preparations (sometimes additional components can be added to them).
The highest therapeutic effect is possessed by drugs containing an aluminum cation, since its presence gives the best combination of drug properties: adsorbing, enveloping, neutralizing and cytoprotective action.However, aluminum hydroxide preparations can cause constipation and act relatively slowly.
Aluminum-magnesium agents are optimal from the point of view of the speed of therapeutic action and the absence of side effects. The combination of magnesium and aluminum hydroxides has a high antacid capacity.
Nevertheless, modern gastroenterology is gradually moving away from the use of antacids, since absorbed antacids often cause acid rebound – an increase in gastric acid production after the end of the drug’s action.Proton pump inhibitors such as omeprazole are increasingly being used instead of antacids. They work reliably for a long time, although the effect from them does not come as quickly as when taking antacids. Proton pump inhibitors reduce the production of hydrochloric acid by blocking a special enzyme in the cells of the gastric mucosa – H + / K + -ATPase, or the proton pump, – the main link in acid secretion.
To reduce the production of digestive enzymes by a diseased organ and stop the development of necrosis resulting from the self-digestion process, special antisecretory drugs are used in therapy.They are necessary to reduce pain in the early stages of acute pancreatitis.
h3-blockers of histamine receptors are able to suppress the synthesis of hydrochloric acid in the stomach by blocking special histamine h3-receptors. Sometimes h3-antihistamines are prescribed as part of enzyme therapy to protect the pancreatic enzyme preparation from gastric enzymes.
With pancreatitis, intoxication often occurs, causing nausea, vomiting and diarrhea, due to which the patient may become dehydrated, blood volume decreases, and the level of electrolytes in it drops.
In the treatment of acute pancreatitis, electrolyte solutions are introduced without fail, the action of which is aimed at restoring the water-salt balance, preventing the occurrence of blood clots. Solutions are administered using a dropper intravenously. As a result, blood viscosity and swelling of the affected gland decrease, and microcirculation of blood in the organ is activated. In addition, the introduction of such solutions can have an anti-shock effect and normalize blood pressure.
Drugs to eliminate concomitant symptoms of pancreatitis
Sometimes additional drugs are prescribed to eliminate concomitant symptoms of a patient with pancreatitis. For example, patients with a severe form of steatorrhea receive vitamins of group B and fat-soluble vitamins of groups A, D, E, K. Also, vitamins are prescribed for enzyme deficiency in order to compensate for the deficiency arising from poor absorption of them from food.
Sedatives are used in case of increased anxiety or excitability of the patient caused by constant pain attacks.In addition, the use of sedatives enhances the effects of pain relievers.
Nausea and vomiting are some of the most unpleasant symptoms of pancreatitis, which can bring a lot of suffering to the patient. Therefore, doctors very often prescribe antiemetic drugs to such patients. At the same time, most drugs taken orally are ineffective in this case – they are replaced by injections.
To reduce the risk of dehydration, anti-diarrhea medications may be prescribed to prevent the removal of water and substances from the body.The use of antidiarrheal drugs prevents disruptions in the water-electrolyte balance, the development of vitamin deficiency, anemia and protein deficiency.
Enzyme therapy for chronic pancreatitis
One of the most important functions of the pancreas is the production of a special pancreatic juice, which contains enzymes for digesting food. A healthy gland produces about two liters of this juice per day. With the normal process of digestion, the juice is promptly excreted into the lumen of the duodenum.But with pancreatitis, the affected gland cannot synthesize enzymes in the required volume, which causes an enzyme deficiency of the pancreas. Violation of enzyme synthesis leads to impaired digestive function.
All types of pancreatitis are capable of causing enzyme deficiency to one degree or another, but clinical manifestations occur only with a significant decrease in the functional activity of the pancreas – by about 90%. The patient develops steatorrhea, flatulence, polyfeces, vitamin deficiency, dehydration, anemia, nausea, vomiting, weight loss.Lack of adequate treatment for enzyme deficiency can cause serious depletion of the patient’s body.
For the treatment of enzyme deficiency in pancreatitis, enzyme therapy can be used. But it should be borne in mind that this method is allowed to be used only in the chronic form of the disease, in all other cases, enzyme preparations are completely prohibited. Only after the exacerbation has been removed, the doctor can prescribe a course of enzyme therapy.
In addition to improving digestion, enzyme-containing preparations can also be involved in relieving pain.This is due to the mechanism of reverse inhibition of enzyme production, since pancreatin in the dosage form, entering in sufficient quantities into the duodenal lumen, leads to inactivation of the cholecystokinin-releasing factor, which contributes to a decrease in cholecystokinin in the blood and pancreatic secretion (according to the principle of “feedback”) … This reduces autolysis, intraductal pressure and pain sensation, providing the pancreas with functional rest during therapy. Indications for it are diarrhea, manifestations of dyspepsia, rapid weight loss and steatorrhea.
Enzyme therapy is most often used in combination with other methods of treatment and a special diet. Self-administration of enzymes for pancreatitis is undesirable if there are doubts about the form of the disease. The doctor should prescribe treatment based on the history, symptoms and severity of the disease. Only in this case, enzymes will be able to help the patient, and not worsen the course of an already dangerous disease.
Pancreatitis – inflammation of the pancreas, accompanied by impaired digestion of food and pain, leading to a gradual replacement of the normal tissue of the gland, scar tissue.
The pancreas has two main functions:
- Production of enzymes that are necessary for the digestion of food.
- The production of insulin, due to a lack of which diabetes mellitus can develop.
Pancreatitis can be complicated by pancreatic necrosis (swelling and necrosis of part of the pancreas). This complication can lead to peritonitis, is life threatening and requires treatment in the surgery department. Only the passage of the course of treatment and the observance of all the doctor’s recommendations will save the patient from an acute attack of pancreatitis and reduce the number of relapses in the chronic form of the disease.
With frequent exacerbations or prolonged course of pancreatitis, exocrine pancreatic insufficiency (insufficient production of digestive enzymes) can form. This leads to impaired digestion of food and is manifested by unstable, poorly digested stools, rumbling, bloating, weight loss, and hypovitaminosis.
A number of factors contribute to the onset of the disease :
- alcohol abuse
- violation of diet (abundant fatty or spicy food)
- diseases of the gallbladder (cholelithiasis, cholecystitis)
- diseases of the stomach, duodenum
- taking certain medications
- metabolic disorders
- some occupational hazards
Treatment of pancreatitis is a complex task that requires an integrated approach, conservative or surgical.
With pancreatitis, there is a violation of the outflow of the digestive juice of the pancreas and its self-digestion, therefore, for the exacerbation to subside, it is necessary to provide the pancreas with functional rest. For this purpose, a sparing diet and antisecretory therapy are prescribed. In addition, treatment is aimed at eliminating concomitant diseases (cholelithiasis and peptic ulcer disease, constipation, etc.)
Pancreatic necrosis requires surgical treatment. The patient undergoes peritoneal lavage (lavage of the abdominal cavity), if necessary, the damaged tissue of the pancreas is removed.
In case of insufficient function of the pancreas, replacement therapy with enzyme preparations is prescribed, sometimes for life.
90,000 Acute and chronic pancreatitis – gastroenterologist – Moscow, Clinic on Sadovy
Acute pancreatitis is an acute
inflammatory process in the pancreas with a variety
involvement of regional tissues and / or involvement of other organs and
In acute pancreatitis, intraductal activation occurs
enzymes (normally enzymes are found in the pancreas in
inactive state) and starting the process of formation of pancreatic necrosis. V
further, the process acquires an avalanche-like character with the formation and
the release of secondary, aggressive factors into the vascular bed –
endotoxins, which in turn lead to the development of endotoxicosis and in
further determine the clinic of the course of the disease.
The main clinical criterion distinguishing acute pancreatitis from
chronic, is the restoration of normal pancreatic function
Pancreatitis in the structure of acute pathology of the abdominal cavity
takes third place – after acute appendicitis and cholecystitis. Previously
it was registered in 9-16% of patients. But over the past 20 years
the incidence of acute pancreatitis increased 40 times, significantly
the frequency of destructive forms increased.
If acute pancreatitis is suspected, the patient needs
hospitalized in the surgical department. Due to the fact that
the pathological process in the pancreas develops extremely
quickly, especially with progressive forms of the disease, it is necessary
hospitalization of patients even with mild pancreatitis.
With early vigorous and multicomponent conservative treatment in
80-90% of patients with acute pancreatitis recover during
3-7 days from the start of treatment.Early hospitalization is essential for
avoiding the progression of acute pancreatitis, preventing the transition
edematous forms of the disease in necrotic, to limit
the prevalence of necrotic changes in the pancreas.
In the early days, cold is shown to the epigastric region, which
suppresses the excretory secretion of the gland. In order to ensure
functional rest of the pancreas, the patient should fast until 7
days. With an uncomplicated course after a decrease in the severity of pain
food intake can be resumed.Food should be taken small
portions (up to 5-6 times a day). It should contain a lot of carbohydrates,
proteins and fats are limited, which reduces the secretion of pancreatic
Not only drug therapy is used in a hospital setting
(infusion-detoxification, antibacterial therapy,
anesthesia, antienzyme drugs), but in some cases and
Chronic pancreatitis – long-term
progressive pancreatic disease characterized by
the appearance during an exacerbation of signs of acute necrotizing
inflammatory process, gradual replacement of the organ parenchyma
connective tissue and growth of exocrine and endocrine
Over the past 30 years, the world has seen a significant increase in the number of
patients with acute and chronic pancreatitis, which is associated with a growing
alcohol abuse, an increase in inflammatory diseases of the gastrointestinal tract.
Most often people aged 31-50 get sick.
Complex treatment of chronic pancreatitis includes the solution of the following tasks:
1) it is necessary to convince the patient to stop drinking alcohol and follow a diet.
2) It is necessary to carry out enzyme replacement therapy in order to
compensation of exocrine pancreatic insufficiency.Therapeutic measures are aimed at preventing the development of complications and
Functional rest of the pancreas is created in the first
turn a diet that restricts the secretion of pancreatic juice and
preventing the provocation of migration of small stones. With pronounced
exacerbations of the disease, table 0 (hunger) is prescribed for 3-5 days. Across
3-5 days the patient is transferred to oral nutrition.Eating should
be frequent (4-6 times a day), in small portions. She must be
finely chopped, with a high content of easily digestible and
well-digestible proteins. Limit food intake
able to stimulate the secretion of the pancreas, in the first place
fats, acidic foods. The patient is prohibited from drinking alcohol,
spicy food, canned food, carbonated drinks, sour fruit juices.
For relief of pain syndrome during exacerbation of chronic
pancreatitis, non-narcotic analgesics, myotropic
In treatment, antihistamines are used to suppress
secretion of the pancreas and the activity of hydrolytic enzymes.
To reduce the stimulating effects of regular peptides on
external secretion of the pancreas and gastric secretion are prescribed
proton pump inhibitors or histamine H2 receptor blockers.
Antacids neutralize HCI and help reduce levels
secretin, thereby provide functional rest of the pancreas
At the same time, drugs that suppress the activity of enzymes are used
pancreas that have entered the bloodstream. Indications for
the appointment of such drugs is severe hyperenzymemia.
With exacerbation of chronic pancreatitis, accompanied by the development
peripancreatitis, cholangitis and other complications, the appointment is indicated
With a decrease in the exocrine function of the pancreas, the presence
signs of malabsorption and steatorrhea for the purpose of substitution therapy
enzyme preparations are prescribed. Doses of these drugs depend on
degree of pancreatic insufficiency.
Enzyme preparations should not lower the pH of gastric juice or
stimulate pancreatic secretion. Duration of treatment
depends on the patient’s condition.
After the exacerbation of chronic pancreatitis subsides, maintenance
therapy must be carried out for 6-12 months. Use
drugs that reduce the secretion of the pancreas: antacids
drugs, antagonists of histamine H2-receptors, PPIs, anticholinergics. At
the presence of exocrine pancreatic insufficiency
it is necessary to prescribe enzyme preparations.
In alcoholic pancreatitis, the main preventive measure for exacerbation
is refusal to drink alcohol, diet.Literate
supportive therapy significantly reduces the frequency of exacerbations in
70-80% of patients.
In case of biliary pancreatitis, it is necessary to sanitize
biliary system. Shown to carry out litholytic therapy
preparations of ursodeoxycholic acid.
90,000 IKBFU researcher: no significant positive effect of acid-lowering drugs in the treatment of acute pancreatitis has been proven
Pancreatitis is the most common disease of the pancreas.This disease leads to the destruction of the pancreas, depriving the body of the production of insulin and digestive enzymes. Acute pancreatitis can turn into pancreatonecrosis (sometimes in a matter of hours), which can lead to death, despite the best efforts of doctors.
In the complex treatment of acute pancreatitis, drugs are usually used that reduce the acidity of gastric juice (for example, omez, kvamatel, etc.). However, to date, there is no exact data on their effectiveness and safety of use in this severe and often fatal disease.
Professor of the Department of Surgical Disciplines of the Medical Institute of the IKBFU I. Kanta Litvin Andrey Antonovich as part of an international research group studied the effectiveness of acid-lowering drugs in patients with acute pancreatitis. The aim of the study was to assess the relationship between the use of acid-lowering drugs, the severity of the outcomes of acute pancreatitis, the incidence of gastrointestinal bleeding and infectious complications in patients with acute pancreatitis.
In general, the study analyzed the results of examination and treatment of 17 422 adult patients with acute pancreatitis. The research results were published in the reputable scientific journal Pancreatology.
As a result of this international cohort study, scientists based on a large research material concluded that acid-lowering therapy should be included in the complex treatment of severe acute pancreatitis. However, according to the results of this study, there was no significant positive effect of the use of acid-lowering drugs on the outcomes of acute pancreatitis, prevention of gastrointestinal bleeding and infectious complications.
Andrey Litvin, Professor of the Department of Surgical Disciplines of the Medical Institute of the IKBFU I. Kant:
“It is always very interesting to work in an international team, especially on such a complex problem as the treatment of acute pancreatitis. The study involved medical researchers from 59 research centers, 23 countries under the auspices of the International Association of Pancreatology and the European Pancreatic Club, of which I am a member.As a result of such work, new ideas appear, new topical directions for research ”.
90,000 Chronic pancreatitis – prices for diagnosis and treatment of pancreatitis in Moscow
First stage of diagnostics interview and examination of the patient
Pain is the dominant symptom in 80-90% of patients with chronic pancreatitis, as well as dyspeptic symptoms, diarrhea, weight loss, diabetes mellitus.The pain is localized in the epigastric region on the right with the predominant localization of the process in the region of the head of the pancreas, with involvement in the inflammatory process of her body – in the epigastric region on the left, with damage to her tail – in the left hypochondrium; often the pain radiates to the back and has a shingles in nature, it can radiate to the region of the heart, imitating angina pectoris. The pain can be constant or paroxysmal and appear some time after eating fatty or spicy foods.The pain increases with the supine position and decreases if the patient sits, bending forward and pulling his legs up to the chest. Dyspeptic symptoms in chronic pancreatitis are almost constant. Complete loss of appetite and aversion to fatty foods are common. However, with the development of diabetes mellitus, on the contrary, patients may feel severe hunger and thirst. Increased salivation, belching, bouts of nausea, vomiting, flatulence, and rumbling in the abdomen are often observed. Stool in mild cases is normal, in more severe cases – diarrhea or alternation of constipation and diarrhea.Characterized by pancreatic diarrhea with the release of abundant (over 400 g / day) mushy fetid feces with a greasy sheen.
Laboratory and instrumental research methods
In the blood – during an exacerbation – increased ESR, neutrophilic leukocytosis, hypoproteinemia and dysproteinemia due to the increased content of globulins. With the development of diabetes mellitus, hyperglycemia and glucosuria are detected, in more severe cases, electrolyte metabolism disorders, in particular hyponatremia.The content of trypsin, antitrypsin, amylase and lipase in the blood and amylase in the urine increases during the period of exacerbation of pancreatitis, as well as when there are obstructions to the outflow of pancreatic juice (inflammatory edema of the head of the gland and compression of the ducts, cicatricial stenosis of the Vater nipple, etc.).
Duodenoradiography reveals deformations of the inner contour of the duodenal loop and depressions caused by an increase in the head of the pancreas.
Ultrasound and radioisotope scans show the size and intensity of the pancreatic shadow.
Computed tomography is performed in diagnostically difficult cases. The exocrine function of the pancreas and the degree of its impairment are assessed by scatological examination, as well as by an elastase test. Intrasecretory function is determined by glucose tolerance test, fasting sugar content is examined.
Chronic pancreatitis (indurative form) is differentiated primarily from a pancreatic tumor, with pancreatoangioregionography, retrograde cholangiopancreatography (virzungography), echography and radioisotope scanning of the pancreas becoming of great importance.There may be a need for differential diagnosis of chronic pancreatitis with cholelithiasis, gastric ulcer and duodenal ulcer (the possibility of a combination of these diseases should also be taken into account), chronic enteritis and, less often, other forms of pathology of the digestive system.
Chronic pancreatitis, treatment of chronic pancreatitis in the NEARMEDIC network of clinics
The pancreas is both an organ of the digestive and endocrine systems of the body.Violation of its functions leads to serious diseases that threaten human life. The inflammatory process disrupts the secretory function of the organ and impairs digestion, and the violation by the cells of the pancreas in the production of insulin causes the development of diabetes mellitus.
At the first symptoms of chronic pancreatitis – moderate or severe girdle pain, severe weakness, vomiting, nausea, you should immediately consult a doctor. Delay threatens the development of a number of serious complications.
NEARMEDIC gastroenterologists, using modern diagnostic methods, will determine the cause of painful sensations, develop an effective treatment regimen, prescribe a diet for chronic pancreatitis, eliminate pain and inflammation of the pancreas, and prevent the development of diabetes mellitus.
To make an appointment or ask questions about the treatment of chronic pancreatitis, call +7 (495) 6 171 171.
Benefits of treatment in our clinics
NIARMEDIC gastroenterologists, doctors of the highest category, specialists with work experience will conduct an accurate diagnosis of chronic pancreatitis, advise on nutrition.Highly qualified employees, based on the results of the examination, will select drug therapy and eliminate the complex of symptoms of chronic pancreatitis.
Own clinical diagnostic laboratory
Diagnostic measures for the determination of chronic pancreatitis in adults begin with laboratory methods. In the NEARMEDIC laboratory, they will quickly and accurately make a complete blood count, and to clarify the diagnosis – a detailed biochemical analysis, including liver enzymes and markers of damage to the pancreas.
Advanced diagnostic methods
The latest hardware diagnostic methods used all over the world are available for our patients: ultrasound on high-precision devices of an expert class will reveal proliferation of connective tissue and diffuse changes. A low-dose x-ray will show calcification of the gland. Localization of dying tissues (in the later stages of chronic recurrent pancreatitis) is detected by CT and MRI.
Diagnostics and treatment of chronic pancreatitis in NEARMEDIC
When signs of chronic pancreatitis appear, to clarify the diagnosis, NEARMEDIC gastroenterologists prescribe a comprehensive examination of the patient: general and biochemical blood tests, urine tests, endoscopic and laparoscopic examinations, CT and PET biopsy CT tissues, ultrasound of the liver and biliary tract.
Treatment of the disease is carried out by conservative or surgical methods, depending on the severity of the course of the disease, as well as the possible development of complications. In the period of exacerbation of chronic pancreatitis, therapy is similar to the treatment of the acute form of the disease.
In the treatment of chronic pancreatitis, including biliary pancreatitis, our specialists practice sparing surgical methods: organ-preserving operations are performed with simultaneous organ reconstruction, preference is given to endoscopic and laparoscopic methods.