Alcoholic pancreatitis is an inflammation of the pancreas induced by alcohol intake. It can occur both against the background of chronic alcoholism, and with a single use of alcohol or its surrogates together with fatty high-calorie foods. At the same time, there are severe shingles in the upper abdomen, nausea and vomiting, fever, diarrhea. The correct diagnosis can be made on the basis of a study of the level of pancreatic enzymes, by ultrasound, CT or MRI, ERCP. Treatment of alcoholic pancreatitis – complete abstinence from alcohol, diet, drug therapy, according to indications – surgical interventions.
Alcoholic pancreatitis is an inflammation of the pancreas that has developed in response to the chronic use of alcohol and its surrogates or with a single intake of alcoholic beverages simultaneously with fatty foods, smoking. About 50% of patients with chronic alcoholic pancreatitis die within 20 years from the onset of the disease, but the cause of death is often diseases associated with alcoholism, and not the pancreatitis itself.
Causes of alcoholic pancreatitis
The cause of the development of alcoholic pancreatitis is a toxic lesion of pancreatic cells by the decomposition products of ethyl alcohol or substances formed by the use of surrogates. At the same time, neither the type nor the quality of alcohol is crucial – pancreatitis can develop both with the daily use of beer, good cognac, and with the use of surrogates.
Recent studies in the field of modern gastroenterology show that alcoholism does not play a decisive role in the development of pancreatitis; a genetic predisposition to this disease is assumed. Also, the induction of pancreatic damage by a combination of several factors is not excluded: drinking alcohol, smoking, eating a large amount of fatty foods depleted in protein.
The pathogenesis of alcoholic pancreatitis is quite complex. When cells are damaged, enzymes are activated and begin to digest the gland itself, causing necrosis of more and more tissues. Swelling of the gland develops, it increases and squeezes the surrounding organs, its shell stretches, causing severe pain. In this case, specific pseudocysts are formed, filled with necrotic tissues and liquid contents.
In the tissues of the gland, the process of fibrosis is triggered, the resulting connective tissue deforms the stroma and ducts, causing stagnation of pancreatic secretions and even greater damage to it. The function of enzyme excretion suffers, and therefore dyspeptic phenomena appear. Eventually, the normal gland tissue is replaced by fat and connective tissue, as a result of which the endocrine function begins to suffer – diabetes mellitus develops.
It is known that alcohol intake causes the formation of free radicals, which have a severe damaging effect on cells. At the same time, smoking provokes vasospasm and pancreatic ischemia, due to which tissue damage increases. The intake of fatty foods activates the production of enzymes, aggravating their damaging effect on the gland.
According to the nature of the course, acute and chronic pancreatitis are distinguished. Acute alcoholic pancreatitis usually develops with simultaneous intake of large doses of alcohol, especially if it was accompanied by smoking, taking fatty and protein-poor food. This form affects mainly young men, it is very difficult.
Chronic pancreatitis can develop both as a continuation of acute and as an independent disease. Studies show that the occurrence of this disease is possible even with a daily intake of only 20 g of alcohol, and the first symptoms may appear after 2 years. But in most cases, the development of chronic pancreatitis is favored by long-term intake of large doses of alcohol.
Alcoholic pancreatitis symptoms
The clinical picture of the disease usually manifests with the appearance of severe shingles, although some cases occur without pain syndrome. The pain is localized in the upper half of the abdomen, radiating into the hypochondria, back. They can be both constant aching and sudden acute. The pain increases in the back position, decreases in the forced sitting position and leaning forward. Also, the pain becomes stronger after eating, and therefore patients often develop a fear of eating. With chronic pancreatitis, the pain can be constant moderate, after drinking or taking fatty, spicy food, it can significantly increase.
Nausea, vomiting, and diarrhea are also often bothered. The stool is abundant, grayish in color, fetid, with a greasy sheen and pieces of undigested food. Also worried about increased flatulence, belching, rumbling in the stomach. Due to a violation of the breakdown and absorption of nutrients (a consequence of insufficient production of pancreatic enzymes), as well as due to the fear of eating, rapid weight loss is noted.
With a complicated course of alcoholic pancreatitis, cysts and abscess of the pancreas, fistulas with neighboring organs or the abdominal cavity, mechanical jaundice, diabetes mellitus can form. Prolonged untreated chronic pancreatitis can lead to the development of pancreatic adenocarcinoma.
Diagnosis of alcoholic pancreatitis in the early stages, before the pancreatic tissue is critically damaged, is almost impossible. At the beginning of the disease, there are no typical signs on ultrasound, nor characteristic changes in the analyzes (for example, the enzyme amylase retains sufficient activity until its production decreases less than 10% of the norm). Symptoms also appear when there is significant swelling and necrosis of the gland tissue.
When collecting anamnesis, the fact of taking alcohol is necessarily recorded. Establishing a diagnosis of alcoholic pancreatitis is also difficult because many hide alcoholism and even a single intake of alcohol.
The symptoms characteristic of pancreatitis dictate the need for a number of studies. At the same time, markers of inflammation (high leukocyte count, changes in the leukoformula, increased ESR) are detected in the clinical blood test. In the biochemical analysis of blood, a change in the activity of pancreatic enzymes is noted, an increase in the level of gamma-glutamyl-transpeptidase is of diagnostic importance, which indicates not only the presence of pancreatitis, but also chronic alcoholism. In the urine, the level of glucose, albumin and transferrin increases. The coprogram contains a large amount of neutral fat, dietary fiber and fatty acids.
To assess the external secretory work of the pancreas, a special test is performed with secretin and cholecystokinin (they stimulate the production of gland enzymes). After their introduction, six samples of intestinal juice are taken from the duodenum, its quantity is estimated. In the first three samples, the level of bicarbonates is determined, in the last – enzymes. The test results allow us to evaluate the digestive function of the pancreas.
Ultrasound of the abdominal cavity organs assess the size of the pancreas, the presence of cysts and calcifications in it, and dilated ducts. Attention is also paid to the condition of the liver and bile ducts, since with pancreatitis their work can also be disrupted. MRI and CT scans of the abdominal organs provide information about the size and location of the gland, cysts and calcination sites, exclude the tumor process. Conducting ERCP (endoscopic retrograde cholangiopancreatography) allows you to assess the condition of the ducts of the gland. To do this, a contrast solution is injected into them using an endoscope, then the result is evaluated on X-rays.
Alcoholic pancreatitis treatment
Treatment of this disease is carried out under the comprehensive supervision of a gastroenterologist, surgeon, endoscopist, endocrinologist, radiologist, psychotherapist, narcologist, and, if necessary, other specialists. The main and by all means necessary condition for healing is the refusal of alcohol, but even in this case it is impossible to guarantee a full recovery. They begin treatment with general measures. In case of severe pancreatitis, therapeutic fasting may be prescribed for several days. In all other cases, the fifth pancreatic table is prescribed, alcohol and smoking are prohibited.
Conservative treatment includes taking enzyme preparations with a substitution purpose, antiemetics and painkillers. The sugar level is monitored, corrected if necessary. Fat-soluble vitamins, essential trace elements are necessarily prescribed.
Surgical treatment consists in opening cysts and abscesses, resection of a part of the gland, disconnection of adhesions, closure of fistula passages. Surgical treatment is required for complicated pancreatitis. If surgery is necessary, the prognosis of the disease worsens. It should be remembered that surgical treatment of pancreatitis significantly increases the likelihood of developing diabetes mellitus.
Prognosis and prevention
The prognosis for chronic alcoholic pancreatitis is unfavorable. In acute course, the outcome depends on the severity of the disease, quite often the disease ends with pancreatic necrosis, which can lead to the death of the patient. Prevention of alcohol-induced pancreatitis consists in complete abstinence from alcohol and cigarettes, proper nutrition with sufficient protein content, annual examination by a gastroenterologist.