As of Tuesday, July 1, 2014
DEAR DOCTOR K: My doctor has diagnosed me with chronic pancreatitis. Could this be related to my drinking? Can this condition be reversed?
DEAR READER: Pancreatitis is inflammation of the pancreas, the large gland that lies behind the stomach. (I’ve put an illustration of the pancreas on my website, AskDoctorK.com.)
Most cases of chronic pancreatitis are caused by long-term overuse of alcohol. Alcohol can bring on acute, or sudden, inflammation of the pancreas. If you keep drinking too much, you often get repeated attacks of acute pancreatitis. The pancreas heals itself after each of the first several attacks and resumes normal function.
However, if you continue to drink after repeated bouts of acute pancreatitis, you are more likely to develop chronic, or lasting, pancreatitis. The pancreas is permanently damaged.
The pancreas has two general roles. First, it produces digestive enzymes that are released into your intestine. The enzymes break apart the food you’ve eaten into tiny, digestible packages. Without this, the energy and nutrients in your food won’t get digested; they won’t get into the blood and be carried throughout the body to all of the cells that need them. As a result, people with chronic pancreatitis can lose weight and become malnourished with vitamin deficiencies.
The pancreas also produces hormones that control the level of sugar in your blood. The best-known hormone is insulin. Over time, a damaged pancreas can fail to produce enough insulin, resulting in diabetes.
Chronic pancreatitis cannot be cured, but you can prevent further damage to your pancreas by eliminating alcohol use.
The most common symptom of pancreatitis is upper abdominal pain. The pain can occur daily or off and on, and it can be mild or intense. Once chronic pain develops, it tends to be long-lasting.
Don’t misunderstand: Pancreatitis is more than just a bad bellyache. An attack of pancreatitis can be very serious, leading to shock and even to death.
For milder types of pain, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin, others) may help. Narcotic medications help control more severe pain. Many patients require long-term pain medications. If your pain isn’t well-managed, consult a pain specialist.
People who quit drinking are more likely to have only mild or occasional pain. If you continue to drink alcohol, you’re more likely to have disabling, daily pain that may require hospitalization. While repeated bouts of pancreatitis from drinking don’t appear to increase the risk of pancreatic cancer, there is a rare inherited form of recurrent pancreatitis that does increase the risk of cancer.
Your doctor will likely prescribe supplemental digestive enzymes. These will help with problems absorbing food, and with resulting vitamin deficiencies. Your doctor also may recommend that you follow a low-carbohydrate, high-protein diet that restricts some types of fats. Once your digestive problems are treated, you should gain back weight you’ve lost. Symptoms such as diarrhea should improve.
If you have diabetes caused by chronic pancreatitis, you will require treatment with insulin.
Pancreatitis can also develop from conditions other than drinking too much alcohol. An example is gallstones. Nevertheless, drinking causes most cases. Therefore, for most people, pancreatitis is a disease they bring on themselves — and that they can prevent from recurring.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.