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Pancreatitis: Overview and Risk Factors

Pancreatitis is an inflammation of the pancreas caused by inappropriate activation of pancreatic enzymes (proteases, lipase, amylase) within and surrounding the pancreas, resulting in autodigestion of pancreatic tissue, necrosis, edema, and possibly hemorrhage.

About 80% of acute pancreatitis cases result from excessive intake of alcohol, which is directly toxic to pancreatic tissue, or from gallstones, which block the flow of pancreatic digestive enzymes. Less common etiologies include hypertriglyceridemia, hypercalcemia, mumps, abdominal trauma, and medications such as azathioprine, ACE inhibitors, valproic acid, thiazides, diuretics, and steroids. Rarely, pancreatitis occurs as a complication of endoscopic retrograde cholangiopancreatography (ERCP). About 10% of cases are idiopathic.

Acute pancreatitis varies from a mild, self–limited condition to a severe pathological process with hemorrhagic necrosis leading to systemic multi–organ failure and death. Clinical presentation includes steady, severe epigastric pain and tenderness that generally follow a large meal or alcohol intake. The pain often persists for hours, radiates to the back, and may be relieved by leaning forward. Further symptoms include abdominal distention, nausea, vomiting, fever, tachycardia, diaphoresis, and jaundice. Severe cases may present with signs of peritonitis (guarding, rebound tenderness, fever), dehydration, and shock.

Chronic pancreatitis is a slowly progressive destruction of pancreatic tissue that occurs over several years due to persistent inflammation and fibrosis. As many as 80% to 90% of cases result from long–standing alcohol abuse, but the condition can also be caused by cystic fibrosis, severe malnutrition, and hyperparathyroidism. Presentation may be similar to acute pancreatitis, with epigastric pain that often radiates to the back, nausea, vomiting, food intolerance, steatorrhea, jaundice, and glucose intolerance. However, chronic pancreatitis may be asymptomatic.

Risk Factors

The annual incidence of pancreatitis in the United States is 4 per 100,000 in Native Americans, 5.7 per 100,000 in Caucasians, and 20.7 per 100,000 in African Americans. 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 or to environmental and lifestyle factors is unclear.

Alcohol use. About 10% of chronic alcoholics will develop acute pancreatitis. From 70% to 80% 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.


Pancreatitis: Diagnosis >>