Alcoholic pancreatitis is a dangerous condition that develops when alcohol damages the pancreas. If not recognised and treated appropriately, alcoholic pancreatitis can have serious consequences.
What is the pancreas and why is it important?
The pancreas is a small but important organ found in the upper part of the abdomen. It is connected to the small intestine via a tube known as the pancreatic duct.
The pancreas contains two types of glands, which both have very important roles.
- Exocrine glands
These glands produce important enzymes. During digestion, the pancreas releases the enzymes into the small intestine. They help break down food into smaller molecules that can be easily absorbed.
- Endocrine glands
These glands produce insulin and glucagon, hormones responsible for regulating blood sugar levels.
What does alcohol do to the pancreas?
The pancreatic acinar cells metabolise alcohol into toxic by-products that can cause severe damage to pancreatic ducts.
These pancreatic enzymes that are normally released into the digestive tract build up and begin to digest the pancreatic tissue itself.
The medical world doesn’t yet know exactly how alcohol consumption causes pancreatitis.
We know that the effects of alcohol cause changes to certain structures within the pancreas. These changes kick off a chain of reactions that lead to damage and inflammation of the pancreas.
What is pancreatitis?
Pancreatitis means inflammation of the pancreas. In simple terms, the pancreas becomes irritated and swollen.
Pancreatitis can affect the ability of the pancreas to carry out its usual functions. If the pancreas stops producing digestive enzymes, the body will struggle to break down and absorb food efficiently.
This can lead to nutritional problems. If the pancreas cannot produce insulin and glucagon, then the body will lose its ability to regulate blood sugar levels. This can lead to high blood sugar and in some cases, diabetes.
The most dangerous effect of pancreatitis is the inflammatory response it triggers in the body. This inflammatory response can make people incredibly unwell. In severe cases, it can cause organ failure and other complications.
Types of pancreatitis
There are two main types of pancreatitis, acute and chronic. While both types cause inflammation they are otherwise relatively different.
Acute pancreatitis due to a sudden episode of inflammation may resolve with treatment, but some attacks are severe and even life-threatening.
Chronic pancreatitis is a more long-standing condition. It usually involves irreversible damage to the pancreas and ongoing symptoms.
With recurrent bouts, acute pancreatitis may develop into the ‘chronic’ type.
How common is pancreatitis?
Acute pancreatitis affects around 56 in 100,000 people each year in the UK.
We do not know exactly how common its chronic counterpart is. The National Institute for Clinical Excellence quotes a statistic of 5 in 100,000 but states that this is probably an underestimate.2
What causes pancreatitis?
The common causes of both acute and chronic pancreatitis are
- gallstones, heavy alcohol use
- genetic disorders of your pancreas
- some medicines
- injury to your abdomen
- pancreatic cancer
- having a procedure called endoscopic retrograde cholangiopancreatography (ERCP) to treat another condition
- pancreas divisum
Causes of acute pancreatitis
Alcohol consumption is responsible for 17-25% of cases, making it the second most common cause1, known as acute alcoholic pancreatitis.
The most common cause of acute pancreatitis is gallstones. Less common causes of acute pancreatitis include injury, viruses and drugs.
Causes of chronic pancreatitis
Alcohol abuse is responsible for 80% of cases.2 known as chronic alcoholic pancreatitis.
This illness can also be caused by a blockage to the pancreatic duct. Less commonly, it can be caused by conditions such as cystic fibrosis.
How much alcohol causes pancreatitis?
Unfortunately, not enough research is available to give us a clear answer to this. Some people may develop pancreatitis from a fairly moderate alcohol intake. Others may drink for years in excess without developing pancreatitis.
However, chronic alcohol consumption is known to put people at far greater risk of health complications such as pancreatitis.
What are the symptoms of pancreatitis?
The main symptoms of acute pancreatitis are severe abdominal pain, nausea and vomiting.
People with pancreatitis usually complain of pain in the top part of their abdomen. The pain may improve slightly on sitting forward.
In acute pancreatitis, the pain is usually sudden and severe. In people where pancreatitis is chronic, the pain may be milder and develop more gradually. In some cases, there may be no pain at all.
In acute pancreatitis, the inflammatory response that occurs can cause additional symptoms including:
- Elevated heart rate/pulse
- Fever or high temperature
In chronic cases, the pancreas can lose its ability to produce digestive enzymes. This can lead to digestive symptoms including:
- Nutritional deficiencies
- Weight loss, bowel habit changes
Your doctor will ask you questions to build an understanding of the problem. They will ask about your symptoms, past medical history, medications, and general lifestyle including alcohol consumption. The information you give can help them identify any potential causes of your problem.
The doctor will then examine you for physical signs. They will look for signs of pancreatitis, and other conditions that might be causing your symptoms.
If your medical team suspects you have pancreatitis they may carry out the following investigations:
- Blood tests
Your medical team can run tests on your blood which will give information on the cause of your symptoms. Patients with pancreatitis often have high levels of an enzyme called amylase. They usually also have high levels of inflammatory markers.
Your medical team might start by carrying out an x-ray first. This might show a different cause of your abdominal pain.
In some cases, your medical team may decide to carry out a computerised tomography (CT) scan straight away. This scan provides a detailed image of the abdomen. Your medical team can use it to look for signs of pancreatitis such as swelling or fluid around the pancreas.
- Specialist investigations
Depending on your individual case, your team might suggest more invasive investigations. If they think something is obstructing the pancreas, they may organise a special scan.
This scan is called Magnetic Resonance Cholangio Pancreatography (MRCP). It provides a clearer picture of the pancreas and the pancreatic duct. This can help your medical team see if there is an obstruction causing pancreatitis.
Treatment of alcohol-induced pancreatitis
Alcohol-related pancreatitis is treated differently depending on whether it is acute or chronic.
Treatment of acute pancreatitis
Developing acute pancreatitis is potentially life-threatening and should be managed in the hospital. Treatment will depend on the symptoms and severity you are experiencing.
Treatment for acute pancreatitis may include:
- Fluids through an intravenous (IV) drip
- Painkillers, medications called antiemetics which help you feel less sick
- Oxygen through a face mask
Acute pancreatitis can rapidly worsen, causing people to become very unwell. For this reason, your medical team will monitor you regularly.
If your pancreatitis becomes severe, your medical team may move you to a special unit for critically unwell patients. If you develop complications, you may need surgery to remove part of the pancreas.
After treating your symptoms, your medical team should focus on helping you to stop drinking alcohol.
Treatment of chronic pancreatitis
Treatment of chronic alcohol-induced pancreatitis has four main aims:
- Controlling pain with carefully monitored painkillers
- Preventing nutritional deficiencies with enzymes and nutritional supplements
- Managing any complications that develop such as diabetes
- Supporting you in making important lifestyle changes including giving up alcohol
Pain relief in pancreatitis
Pain is an ongoing issue for people with pancreatitis. Your doctor will advise you on which painkillers you should take.
For mild pancreatitis pain, you will usually take simple painkillers. For example, paracetamol and non-steroidal anti-inflammatories (NSAIDs) like ibuprofen. If these do not control the pain, your doctor may prescribe a weak opioid such as codeine phosphate.4 However, codeine and other opioids tend to lose their effect if taken regularly and should not be used long-term.
If your pain is severe your doctor may offer you more specialist medications. For example, gabapentin or amitriptyline. (4)
Patients with uncontrollable pain may require a specialist intervention called a nerve block.4
Is pancreatitis dangerous?
Acute pancreatitis complications
Acute pancreatitis can lead to a range of severe complications. Risk factors include:
- Irreversible damage and death of pancreas tissue (known as pancreatic necrosis).
- Formation of fluid-filled sacs known as pseudocysts.
- Bleeding from blood vessels around the pancreas
- Formation of a clot in nearby blood vessels
- Inflammation and swelling of the gallbladder (known as cholecystitis)
- Pancreatitis can become chronic
Chronic pancreatitis complications
This type of pancreatitis can also lead to a range of complications:
- Pseudocysts, diabetes
- Blockage of the bile duct
- Formation of a clot in the splenic vein
- Pancreatic cancer2
Recovery from alcohol-related pancreatitis
Can you recover from acute pancreatitis?
Most people recover from an episode of acute pancreatitis after around a week of hospital treatment. In cases of severe pancreatitis, people may be in hospital for weeks before they recover.
After you recover from acute pancreatitis your medical team will give you advice on lifestyle changes you should make. These will help you to prevent further episodes. One of the most important changes is giving up alcohol.
Can you recover from chronic pancreatitis?
If pancreatitis becomes chronic, this could result in irreversible damage. For this reason, it is not possible to completely recover. But with the right medical support and good lifestyle changes you can control your symptoms and reduce flare-ups. If you develop pancreatitis resuming drinking alcohol is likely to cause further damage to the pancreas and/or an acute attack.
Do I need to stop drinking if I have pancreatitis?
If you have had an episode of alcoholic pancreatitis, you should stop drinking alcohol completely. The effects of alcohol abuse present an increased risk of developing acute alcohol-induced pancreatitis.
People who continue to drink alcohol after an episode of acute pancreatitis are at higher risk of:
- Having another episode of acute pancreatitis
- Developing chronic pancreatitis (1)
For people with alcohol addiction, we know that quitting can be a difficult process. Addiction is a complex disease and even if you know you must stop drinking for the sake of your health, it may not be easy. More.
Smoking can worsen pancreatitis,2 so your doctor may also suggest quitting smoking.
Stopping alcohol after pancreatitis
Certain hospitals have addiction services that can support you in stopping drinking. These services can offer guidance for how you can stay away from alcohol after returning home from the hospital.
Some people find that they need more support in overcoming alcohol addiction. If you need more support, you may wish to consider residential rehab treatment.
Getting treatment for alcohol addiction
If you’re struggling with a severe alcohol use disorder, we can help. Castle Craig is a world-renowned residential rehab clinic offering intensive alcohol addiction treatment. A 24/7 medical officer is on duty, and we liaise with specialists if needed when patients are admitted with complex medical complications of their drinking.
Our programme aims to help complete abstinence from alcohol which is what our patients with pancreatitis have usually already been advised to aim for.
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1. Klochkov A, Kudaravalli P, Lim Y, Sun Y. Alcoholic Pancreatitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 24, 2021.
2. Pancreatitis | Guidance | NICE. Nice.org.uk. https://www.nice.org.uk/guidance/ng104/chapter/Context Published 2021. Accessed December 3, 2021.
3. Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019;14:27. Published 2019 Jun 13. doi:10.1186/s13017-019-0247-0
4. Management of chronic pancreatitis | Guidance | NICE. Nice.org.uk. https://cks.nice.org.uk/topics/pancreatitis-chronic/management/management-of-chronic-pancreatitis/. Published 2021. Accessed December 3, 2021.
Authors: Professor Chick and Dr India Duane?