The pancreas plays a vital role in converting the food we eat into fuel for our body. It has two main functions:
- Releasing digestive enzymes to help with the digestion process
- Regulating our blood sugar levels through hormones such as insulin and glucagon.
Pancreatitis is a condition where the pancreas is inflamed. This can be triggered by a variety of causes, including alcohol consumption, gallstones, infection, obesity, certain medications, injuries to the pancreas, pancreatic structural abnormalities and genetic risk factors.
In most cases, pancreatitis causes patients to experience severe abdominal (stomach) pain, fever, nausea and vomiting. Depending on the type of pancreatitis, blood sugar levels could be affected as well as reduced digestion of food leading to malnutrition. Build-up of fluids and debris in the pancreas can cause painful pseudocysts, and there is a high risk of pancreatic cancer in those with hereditary pancreatitis.
There are two types of pancreatitis:
Acute Pancreatitis
 Typically presents with a sudden onset and short duration. While unlikely, this type of pancreatitis has occasionally been shown to cause longer-term pancreas damage.
Chronic Pancreatitis
Develops gradually and can worsen over time. This type of pancreatitis causes irreversible scarring of the pancreas (pancreatic fibrogenesis) as a result of prolonged inflammation. Chronic pancreatitis is typically considered more severe than acute pancreatitis as it can cause decreased pancreatic function over time.
Risk Factors
You are at risk of chronic pancreatitis if you:
- Consume alcohol excessively
- Are a smoker
- Suffer from gallstones
- Are on medication known to damage the pancreas
- Are obese
- Are 50 years or older
- Have a family history of pancreatitis.
Avoiding or Alleviating Pancreatitis
You can reduce the risk of pancreatitis or alleviate its symptoms through a change in your lifestyle:
- Healthy diet and weight
- Avoiding excess alcohol/tobacco consumption
- Regular exercise/active lifestyle
- Regular health checks and good management of complications known to be associated with pancreatitis, such as gallstones, pseudocysts and pancreatic infections.
About Hereditary Pancreatitis
The concept of chronic pancreatitis with a genetic background (hereditary pancreatitis) was first reported by Comfort and Steinberg in 1952. Relatively recently in 1996, a gene mutation (PRSS1) was found to be a cause of hereditary pancreatitis in families. Since then, more mutations have been found through medical research, to cause and exacerbate pancreatitis, including the SPINK1, CFTR and CTRC genes.
A person with hereditary pancreatitis has an 80% chance of passing the gene on to their children. Patients with this type of chronic pancreatitis typically experience symptoms at a very young age and suffer the burden of disease from their teenage years all the way through adulthood. As a result of this early age of onset and prolonged inflammation process, patients with hereditary pancreatitis are at higher risk to loss of pancreatic functions and potentially pancreatic cancer in later life. Hence, early treatment is in most cases recommended.
Treatment
Pain relief is standard management for acute and mild chronic pancreatitis cases. Once the disease becomes more advanced, the pancreas may need to be either drained or the inflamed parts surgically removed.
Patients with hereditary pancreatitis usually receive pain management and continue to have their pancreatic function monitored. Up to 60% of patients will ultimately require surgical intervention due to the intolerable abdominal pain and inevitable loss of pancreatic function caused by repeated inflammation.
The aims of the medical interventions are to reduce severe pain and prevent further damage to the pancreas. Total Pancreatectomy with Islet Auto Transplantation (TP-IAT) is a possible treatment for people with severe, chronic pancreatitis. This procedure removes the diseased pancreas and reimplants the insulin producing islet cells, isolated from the removed pancreas back into the patient’s liver. TP-IAT has the benefit of providing patients with some pancreatic function (insulin production), while eradicating the cause of the pain. Those with hereditary pancreatitis also benefit by preventing the risk of pancreatic cancer due to the pancreas being removed.
The Royal Adelaide Hospital is currently the only hospital in Australia that offers this procedure, with proud support from Kidney Transplant and Diabetes Research Australia. Patients from across the country have benefitted from TP-IAT surgery in Adelaide.
