Medical Edge Newspaper Column

Managing Pancreatitis Often Requires Lifestyle Changes, Dietary Restrictions

August 21, 2009
Dear Mayo Clinic:
My son recently had an attack of pancreatitis and was in severe pain for about six days. What causes pancreatitis? I understand diet may play a part, but he did not receive any specific dietary instructions. Are there foods he should avoid?

Answer:
Pancreatitis, an inflammation of the pancreas, may appear suddenly and last for several days (acute pancreatitis), as in your son's situation. Or it may progress slowly over time, growing increasingly more severe and eventually leading to permanent organ damage (chronic pancreatitis). A wide variety of medical conditions and other factors can cause pancreatitis. In addition to addressing the underlying cause, people with pancreatitis are often advised to make lifestyle changes that include some dietary restrictions.

The pancreas is a long, flat gland tucked behind the stomach in the upper abdomen. It produces enzymes that help digestion, as well as hormones that help regulate how the body processes sugar (glucose). Pancreatitis occurs when those enzymes become activated too soon.

During normal digestion, enzymes move through ducts in the pancreas and travel to the small intestine, where they become activated and help with digestion. In pancreatitis, the enzymes become activated while they are still in the pancreas (a process known as autodigestion). This causes irritation of the pancreas cells, resulting in inflammation and leading to the signs and symptoms associated with pancreatitis, such as severe abdominal pain, abdominal tenderness, nausea and vomiting.

Repeated bouts of acute pancreatitis may damage the pancreas and can lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of pancreatic function. A poorly functioning pancreas may result in digestive problems and diabetes.

The most common causes of pancreatitis are gallstones and chronic alcohol use. Other medical conditions that can cause pancreatitis include cystic fibrosis, viral infections, tumors, high blood levels of calcium (hypercalcemia), parathyroid hormone (hyperparathyroidism) or triglycerides (hypertriglyceridemia). Pancreatitis also can result from abdominal surgery or injury to the abdomen. In addition, cigarette smoking, a family history of pancreatitis, and certain medications — particularly estrogens, thiazide diuretics and the immunosuppressant azathioprine — have been linked to pancreatitis in some people.

Most people with pancreatitis are counseled not to smoke or drink alcoholic beverages because either can increase the risk of pancreatitis recurrence. A diet that includes plenty of fresh fruits and vegetables, whole grains and lean protein, and limits fats is often a good choice for people with a history of pancreatitis. In cases of chronic pancreatitis, a diet that includes low-fat meals that are smaller and more frequent than usual may help reduce abdominal pain.

Treatment for pancreatitis typically involves a hospital stay to control the inflammation and relieve pain. Once pancreatitis is under control, the health care team works to identify and treat the underlying cause. For those with gallstones, treatment should involve gallbladder removal (cholecystectomy). In some people, pancreas surgery may be necessary to drain fluid from the pancreas or to remove diseased (necrotic) tissue.

Your son should talk to his doctor to obtain more information about dietary changes that are right for his situation. For some people a consultation with a registered dietitian can be helpful for planning low-fat, nutritionally balanced meals that may help reduce symptoms of pancreatitis.

— Randall Pearson, M.D., Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.