Pancreatitis: Promising Research Could Help Painful Condition
By Jerry Berger
Beth Israel Deaconess Medical Center Staff
It starts with a pain in the abdomen, sometimes so bad it "feels as if you've dropped 30 lit cigarette butts" into it. Add waves of nausea and a high fever and it's likely your next stop is the emergency department.
"It" is pancreatitis, a condition where the enzymes manufactured by this organ to help a person digest food in the intestine actually begin to digest the pancreas itself.
Pancreatitis "always brings people to the hospital because they are so sick," says
Dr. Steven Freedman, Director of the Pancreas Center at Beth Israel Deaconess Medical Center. "The symptoms are as if you dropped 30 lit cigarette butts" into the epigastrium, the upper end of the abdomen beneath the breast bone. Often the pain can also move into the back.
Despite the common perception that stomach acids are the principal tools the body uses to digest food, Freedman says the pancreas is the center of the digestive process - creating enzymes that breakdown carbohydrates, fats and proteins. In a normal body, those enzymes are released into the intestine to begin the digestive process.
But when something goes wrong - if a pancreatic duct becomes blocked by a gallstone, or if a person has high triglyceride levels, abuses alcohol or is genetically predisposed to problems - the digestive enzymes wind up being released within the pancreas. The condition is easily detectable by a blood test.
"These enzymes basically break down everything you eat - proteins, carbohydrates, fats. Imagine if these enzymes are prematurely activated within the pancreas itself. The pancreas would digest itself," Freedman explains.
The only real treatment is hospitalization, says Freedman. Patients are put on intravenous fluids, pain and anti-nausea medications and are given a chance to "rest" the pancreas. Some patients may wind up in intensive care because breathing can become labored.
Cases of acute pancreatitis usually resolve themselves in two-to-three days. Less fortunate are people with a chronic form of the disease, one that leaves them in virtually constant pain.
"The major problem in chronic pancreatitis is unrelenting pain, for which people are on a significant amount of narcotics," says Freedman. "Unfortunately they are treated poorly by many physicians, especially in emergency rooms because they are thought to be drug-seeking individuals who are closet alcoholics."
BIDMC researchers led by Freedman have also noted that half of the patients who present with unexplained chronic pancreatitis have mutations in the gene that carries cystic fibrosis, a genetic disease that causes certain glands to produce abnormal secretions, resulting in tissue and organ damage.
"That is part of why I think our research linking this disease with mutations in the cystic fibrosis gene has really been important," says Freedman.
Other research at BIDMC is looking into the potential to treat this chronic pain with transcranial magnetic stimulation, a non-invasive procedure using magnets to change brain behavior. For now, the best way to avoid pancreatitis is to watch what you eat and drink. A poor diet and obesity can lead to the creation of gall stones that can block the pancreatic duct. Fatty meats and other "wrong" fats can add to the problem. As little as a half bottle of wine, four bottles of beer or five ounces of liquor daily for several years can also trigger an attack.
"It's been 110 years since (Reginald) Fitz described acute pancreatitis and nothing has changed," says Freedman.
Above content provided by Beth Israel Deaconess Medical Center.
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Posted December 2009