Alcohol-Induced Pancreatitis: Avoiding the Risks

If you were asked what health risks and complications are associated with alcohol abuse, what would you say? A weakened immune system? Liver cirrhosis? Heart disease?

You’d be right since all those health risks are associated with abuse of alcohol.

But another less understood though common health risk is alcohol-induced pancreatitis.

The pancreas is a large gland that is located behind the stomach and adjacent to the small intestine, in the upper part of the abdomen.

The pancreas plays two major roles:

• Releasing digestive enzymes to aid in the digestion
  process in the small intestine.
• Secreting the hormones glucagon and insulin to regulate
  blood sugar levels and control how the body uses food for energy.

Let’s explore the relationship between alcohol use and abuse and alcohol-induced pancreatitis:

What is pancreatitis?

Pancreatitis is when the pancreas becomes swollen and inflamed hence damaging its cells.

Pancreatic damage as a result of pancreatitis or other issues occurs when the digestive enzymes that are secreted by the pancreas become active in the pancreas before they are released into the small intestine.

When these digestive enzymes which are normally activated in the small intestine become activated in the pancreas instead, they start attacking this important organ.

Forms of alcohol-induced pancreatitis

There are two types of pancreatitis: acute pancreatitis and chronic pancreatitis.

1. Acute pancreatitis

Acute alcohol-related pancreatitis is an abrupt inflammation of the pancreas that lasts for a very short period of time. Its severity can range from mild to life-threatening.

Most cases of acute pancreatitis usually result in complete recovery after getting the right treatment.

However, some severe cases can result in infection, the formation of cysts, bleeding into the gland, fluid collection in the abdomen and even tissue damage. Severe acute pancreatitis can also damage other organs such as the lungs, heart, and kidneys.

Acute pancreatitis can present as an episode of nausea, vomiting and abdominal pain and in some severe cases may be accompanied by circulatory collapse and profound metabolic abnormalities.

Acute episodes of alcohol-induced pancreatitis may recur and are usually caused by an increase in alcohol consumption.

Complications such as pancreatic endocrine and exocrine insufficiency, leakage of pancreatic fluid and narrowing of the bile duct may develop resulting in pseudocyst formation, malabsorption, jaundice and diabetes.

The most common cause of acute pancreatitis is gallstones, followed closely by use and abuse of alcohol, and then by various less common causes.

However, it’s essential to note that alcohol-induced pancreatitis is the most dangerous, mainly because it can easily lead to chronic alcohol-related
pancreatitis.

2. Chronic pancreatitis

Chronic pancreatitis is a long-standing condition that continues even after the original trigger has been resolved.

This long-lasting and severe inflammation of the pancreas typically happens after one or more episodes of acute pancreatitis.

The condition is characterized by irreversible damage and scarring of the pancreatic tissue. Although there are many potential causes of chronic pancreatitis, one of the main causes is heavy alcohol use.

Damage to the pancreas as a result of chronic alcohol use may not cause any significant symptoms for several years. However, in some cases, the person may suddenly develop symptoms of chronic pancreatitis.

The main clinical symptoms of chronic alcohol-induced pancreatitis include abdominal pain and discomfort coupled with maldigestion/malabsorption and diabetes resulting from endocrine and exocrine insufficiency.

The natural history and stages of alcohol-induced pancreatitis are difficult to characterize largely due to the fact that patients usually present having suffered from symptoms of pancreatitis for varying periods of time.

Moreover, a biopsy of the pancreatic tissue is rarely done unless doctors suspect malignancy. Nevertheless, the process can be arrested by withdrawing from alcohol consumption at an early stage.

Even when the disease is established, withdrawing from alcohol can reduce the frequency of inflammatory episodes and even allow for better control of both endocrine and exocrine insufficiencies.

Symptoms of pancreatitis

1. Symptoms of acute pancreatitis

In most cases, acute pancreatitis comes on pretty quickly. Even though the pancreas becomes inflamed, there usually isn’t any permanent damage and the effects only last a few days.

Some of the common symptoms of acute pancreatitis include:

• Severe, steady abdominal pain that may radiate through the back and shoulders. The pain may be aggravated by eating foods high in fat.
• Abdominal tenderness or bloating
• Clammy skin
• Increased heart rate
• Nausea and vomiting
• Low-grade fever
• Tender and swollen abdomen
• Rapid pulse
• Lowered blood pressure

If not treated promptly, acute pancreatitis can easily become a serious condition.

However, with prompt and proper treatment, most people are able to recover and avoid serious or even life-threatening complications.

If the use and abuse of alcohol is the main underlying cause, doctors recommend that patients eliminate alcohol consumption completely.

Therefore, even after a full recovery, additional steps are needed to address the cause of acute pancreatitis.

After an acute episode of pancreatitis, continued consumption of alcohol is
dangerous and can lead to the development of the chronic form of pancreatitis.

2. Symptoms of chronic pancreatitis

Chronic pancreatitis occurs as a result of permanent inflammation of the pancreas which causes to stop working properly.

Symptoms of chronic pancreatitis include:

• Recurring, severe pain in the abdomen that radiates through the back and ribs. In some cases, the pain may be disabling
• Back pain
• Weight loss and diarrhoea caused by malabsorption (poor absorption) of food. Poor absorption of food happens because the pancreas is not releasing enough digestive enzymes to aid in breaking down food
• Patients may develop diabetes if insulin-producing cells are damaged.
• Jaundice (yellowing of the eyes and skin)
• Steatorrhea (producing oily, foul-smelling stools as a result of poor absorption of fat)

Once a patient develops chronic pancreatitis, various other complications such as chronic pain, nutritional deficiencies, diabetes and even pancreatic cancer can occur.

Both forms of alcohol-induced pancreatitis can be caused by alcohol abuse.

Although the symptoms of alcohol-induced chronic pancreatitis are similar to those of alcohol-induced acute pancreatitis, the effects of chronic pancreatitis typically last for much longer and are mostly permanent.

Patients of chronic pancreatitis may require drugs to aid in regulating blood sugar and in the digestion of food for the rest of their lives.

Chronic pancreatitis patients are also at risk of developing diabetes if the insulin-producing cells in the pancreas are damaged.

Chronic pancreatitis can also cause other complications such as pseudocysts, also known as pancreatic cysts. One of the key mitigating steps chronic pancreatitis patients need to implement is ceasing to consume alcohol.

Ceasing to consume alcohol halts further damage to the pancreas and it may even arrest the development of the disease into retreat.

What are the causes of acute pancreatitis?

Although gallstones and excessive drinking are the leading causes of pancreatitis, the disease can also be caused by other factors and conditions such as surgery, autoimmune disease, infections, medications, trauma and metabolic disorders.

However, in about 15% of acute pancreatitis patients, the cause is unknown.

What are the causes of chronic pancreatitis?

In up to 70% of people suffering from chronic pancreatitis, the condition is caused by long-term alcohol use and abuse.

Other causes of chronic pancreatitis include cystic fibrosis, hereditary disorders, gallstones, certain medicines, and high triglycerides.

In up to 30% of chronic pancreatitis cases, the cause is unknown.

Diagnosis of pancreatitis

Procedures and tests used to diagnose either acute or chronic pancreatitis usually include:

• Blood tests to analyze the levels of digestive enzymes in the blood. Elevated levels of amylase and lipase enzymes along with the symptoms mentioned above may indicate acute pancreatitis
• Pancreatic function tests to determine whether the pancreas is producing enzymes in the right amounts
• Biopsies
• Urine tests to help determine the presence of any enzymes or bile that may point to pancreatitis
• CT (Computerized Tomography) scan to assess the extent of inflammation of the pancreas and look for gallstones
• Abdominal ultrasound to determine whether there’s any pancreas inflammation and look for gallstones
• Stoll tests to measure the level of fat in the stool. Elevated levels of fat could
  suggest the digestive system is not absorbing nutrients properly, which is one
  of the major symptoms of chronic pancreatitis
• Tolerance tests to measure the extent of damage to the pancreas
• Endoscopic ultrasound to look for blockages and inflammation in the bile duct or pancreatic duct
• MRI (Magnetic Resonance Imaging) to look for abnormalities in the pancreas, gallbladder and ducts

The doctor may recommend other procedures and tests depending on the particular situation of the patient.

Treatment for pancreatitis

1. How is acute pancreatitis treated?

Acute pancreatitis is usually treated with pain medications and IV fluids in the hospital. However, in some people, the condition may be severe and some may need to be admitted to the ICU (Intensive Care Unit).

Such patients usually need to be closely monitored because severe cases of acute pancreatitis can damage vital organs such as the kidneys, lungs, or heart.

In some severe cases, pancreatitis can result in damage or death of pancreatic tissue and in case infection occurs, surgery may be required to remove the damaged or dead tissue.

2. How is chronic pancreatitis treated?

Chronic alcohol-induced pancreatitis can be hard to treat. Your doctor may try to relieve your pain and improve nutrition problems using medications.

Severe pain can be relived with options such as surgery or endoscopic ultrasound. Your doctor may recommend pancreatic enzymes, a low-fat diet, or even insulin.

In some cases, surgery may be done to help restore drainage of pancreatic hormones or enzymes, relieve abdominal pain, reduce the frequency of attacks, or unblock the pancreatic duct.

It is critical for pancreatitis patients to take the proper medication, follow their
doctor’s dietary advice and stops drinking alcohol and smoking in order to have milder and fewer pancreatitis attacks.

References

1. https://www.ncbi.nlm.nih.gov/books/NBK65575/

2. https://www.webmd.com/digestive-disorders/picture-of-the-pancreas

3. https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis/symptoms-causes

4. https://www.health.harvard.edu/a_to_z/chronic-pancreatitis-a-to-z

5. https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis/diagnosis

6. https://pancreasfoundation.org/patient-information/chronic-pancreatitis/

7. https://journals.lww.com/pancreasjournal/Abstract/2003/11000/The_Epidemiology_of_Alcohol_Induced_Pancreatitis.2.aspx