While the talk around gastric issues has remained limited to the liver, the clinical discipline has another vital organ which determines overall health, the pancreas. Dr Anoop Saraya, former Head of the Department in Gastroenterology & Human Nutrition department, AIIMS Delhi, speaking to Ashish Srivastava, discusses how pancreatitis, once termed as the ‘disease of the South’ due to concentration of cases in South India, is now highly prevalent in the North too, and how chronic cases can lead to pancreatic cancer. Excerpts:
What is pancreatitis and what causes it?
Pancreatitis is an inflammation of the pancreas and has various types. In acute conditions, patients suffer pain in upper abdomen for more than 8-10 hours, which at times radiates to the back and is associated with vomiting and distension of the abdomen. The common causes include alcohol intake and gallstone. But after an episode of acute pancreatitis, once the inflammation subsides, there is recovery of pancreatic tissues to a great extent. But in chronic cases, there is irreversible damage to the tissues which may lead to exocrine and endocrine deficiency. However, in 30-40% cases, causes are not discernable and are identified by idiopathic pancreatitis.
Does it manifest over other parts of the body as well?
There are various complications of chronic pancreatitis. The cardinal symptom of chronic pancreatitis is recurring episodes of pain in the abdomen and endocrine deficiency in form of diabetes and steatorrhoea which is characterised by excretion of abnormal quantities of fat with faecal matter because the enzymes responsible or required for digestion of fat is deficient. The recurring episodes can also result in narrowing of vessels in the vicinity of pancreas leading to clot formation which may turn into segmental portal hypertension as well.
A 2004 survey revealed high prevalence of pancreatitis in South India. What has changed in two decades?
There is no change as such, but epidemiologically, when we started our career in gastroenterology, pancreatitis was considered as a ‘disease of the South’. It was implicated that consumption of certain foods in this geographical area can cause damage to pancreatic tissues. Cassava used to be implicated cause of chronic pancreatitis but that was proved to be a myth. But once we started looking into it, we found high prevalence of this disease in the North as well. So, it may be a hereditary condition, certain mutations in the genes, or recurring injuries to the pancreas due to certain toxins which is driving the incidences.
Can chronic pancreatitis lead to pancreatic cancer?
With cases of chronic pancreatitis, there is an increased risk of developing malignancy. Incidents of pancreatic cancer is also high among patients of chronic pancreatitis. They are considered as high risk group for carcinoma pancreas. Such patients must be kept under regular supervision and diagnosis and their deficiencies should be treated. If they have exocrine deficiency, enzyme supplementation is required. In endocrine deficiency, diabetes is treated. If any weight loss in such patients is observed due to steatorrhoea or uncontrolled diabetes, then doctors should go for early diagnosis of pancreatic cancer. However, in this type of cancer, the prognosis is not very good. It’s a dreaded disease as 5-year survival is less than 5% and median survival in cases which are inoperable is less than 6 months. Resection is possible in around 10% cases only.
Since survival rate is very low, what should people do to prevent this condition?
One must give up alcohol and smoking. These are two important risk factors. If a patient is a chronic smoker, and continues to drink even after developing pancreatitis and eats food high in toxins and animal proteins, it may lead to high oxidative stress, which can cause certain mutations in the pancreatic tissue and predispose the patient to pancreatic cancer.
