Pancreatitis is a condition of inflammation in the pancreas, an organ in the abdomen that produces hormones and digestive enzymes. Normally, digestive enzymes are produced in the pancreas and released into the intestine after meals. In cases of pancreatitis, these enzymes become inappropriately activated within the pancreas, resulting in digestion and damage of the pancreas itself.

More than half of cases are due to alcohol intake. Gallstones are another common cause. Less common contributors include trauma, certain medications (e.g., azathioprine, ACE inhibitors, valproic acid, diuretics, and steroids), and mumps infection.

The severity of pancreatitis varies from mild to life-threatening. Most cases require hospitalization.

Symptoms

• Steady, severe upper abdominal pain that generally follows a large meal or alcohol intake. The pain often persists for hours, radiates to the back, and may be relieved by leaning forward.
• Abdominal distention
• Nausea, vomiting
• Fever
• Tachycardia (abnormally rapid beating of the heart)
• Sweating
• Jaundice (yellow discoloration of the skin and eyes)

Risk Factors

• Race: African-Americans have an increased risk. The risk among African-Americans aged 35 to 64 is 10 times greater than for any other demographic group. Whether the increased incidence is related to genetics is unclear.
• Alcohol use: About 10 percent of chronic alcoholics will develop acute pancreatitis and 70 to 80 percent of heavy alcohol users will develop chronic pancreatitis.
• Gender: Acute pancreatitis due to gallstones is more common in women, reflecting the greater prevalence of gallstones in women.
• Elevated triglyceride levels

Pancreatitis: Diagnosis and Treatment

Diagnosis

• The evaluation begins with a medical history and a physical examination.
• Blood testing is used to evaluate for pancreatic damage, rule out liver damage, and measure for electrolyte imbalances.
  
• Abdominal X-rays, CT scan, and ultrasound may be used to check for pancreatic damage and gallstones and to rule out other abdominal disorders.  
• A procedure called endoscopic retrograde cholangiopancreatography, or ERCP, is often used to look closely into the pancreas to identify damage and gallstones and may also be used to remove gallstones.

Treatment

• Individuals with pancreatitis are generally treated in the hospital. They require close monitoring, intravenous fluids, pain medication, and antinausea medication. Also, bowel rest is necessary: Patients cannot eat or drink, and a tube may be placed from the nose or mouth into the stomach to relieve the pancreas of its workload.
• Addressing the underlying cause is a priority. For example, the patient should avoid alcohol and fatty foods. If pancreatitis occurred due to gallstones, surgical removal of the gallbladder may be necessary.

Pancreatitis: Nutritional Considerations

The following nutritional factors are important in pancreatitis management.

• Avoidance of alcohol: Avoidance of alcohol reduces the risk of both acute and chronic pancreatitis. 
• Maintaining a healthy body weight: Overweight appears to be an important risk factor for the development of pancreatitis and obese patients also tend to have more severe disease. Furthermore, obesity is a strong risk factor for gallstones. Diets low in fat and high in fiber are helpful for gallstone prevention and for obesity prevention and management.
• Reducing triglyceride concentrations: Foods that are high in fat and "simple" sugars are known to increase triglycerides, which is the chemical form of fat in the body. As such, a low-fat diet with low levels of sucrose (table sugar) and high fructose corn syrup may be effective to reduce triglycerides. It is helpful to choose foods that are rich in fiber and complex carbohydrates, including beans, whole grains, and vegetables.
  
  The exception may be omega-3 fatty acids. These "healthy" fats may reduce triglycerides by 30 to 50 percent. Healthful sources of omega-3 fatty acids include nuts (e.g., walnuts), seeds (e.g., flax and pumpkin), and green leafy vegetables. Some species of fish also provide some omega-3 fatty acids, but the quantity of fat, cholesterol, and, in some cases, pollutants such as mercury, raise concerns about including fish in the diet.
• An antioxidant-rich diet: Blood concentrations of several antioxidants and related substances, including selenium, vitamin A, vitamin E, and carotenoids, have been observed to be decreased in patients with chronic pancreatitis. Some studies suggest that antioxidant supplements may be helpful in these patients to decrease pain, prevent recurrence, and reduce the need for surgery.