Alcoholic pancreatitis

Alcoholic pancreatitis is a serious illness that may need hospitalization for proper treatment. In the last 15 years, I have personally treated patients hospitalized with alcoholic pancreatitis. I am writing this article based on my personal experience as well as a review of relevant medical literature.

  1. How alcohol causes pancreatitis
  2. How much alcohol you need to drink to be concerned about pancreatitis
  3. Difference between acute and chronic alcoholic pancreatitis
  4. When you need to be hospitalized for alcoholic pancreatitis
  5. What to expect when hospitalized with alcoholic pancreatitis

How alcohol causes pancreatitis

Your pancreas produces digestive enzymes. These enzymes help digest protein, fats, and other nutrients in your food. The enzymes are supposed to be released into your intestine in a controlled manner. They are only supposed to be released when there is food in the intestine that needs digesting.

A diagram showing how alcohol causes corrosive enzymes to inflame the pancreas and cause alcoholic pancreatitis.
A diagram showing how alcohol can lead to an inflamed pancreas and alcoholic pancreatitis

Alcohol is toxic to the pancreas. Inside the pancreas, alcohol is converted to other chemicals. This conversion takes a toll on your pancreas. Chemical reactions occur, and it ends up raising the levels of calcium inside the cells of your pancreas. A rising calcium level is also the signal used by your body to tell the pancreatic cells to build and release digestive enzymes. When alcohol raises the calcium levels, these cells begin to release digestive enzymes haphazardly. These enzymes are very corrosive and cause inflammation and damage of normal organs and tissues in and around your pancreas. This results in a painful condition leading to alcoholic pancreatitis.

Alcohol may go one step further and directly damage your pancreas. Sometimes, alcohol undergoes even worse chemical reactions, and damages the energy-producing mechanism of the pancreatic cells. Eventually, these cells begin to die off. The dead cells burst open, and all the digestive enzymes inside suddenly come out. This immediate release of large amounts of corrosive enzymes wreaks havoc. You get severe alcoholic pancreatitis.

How much alcohol causes pancreatitis?

Unfortunately, today’s medical science doesn’t have a very reliable answer to this question. It seems like different people’s pancreases differ when it comes to the toxic effects of alcohol. Some people are especially vulnerable, and get alcoholic pancreatitis with a relatively lower alcohol consumption. Others never develop alcoholic pancreatitis despite heavy alcohol use everyday. In general, most people who develop alcoholic pancreatitis have at least 5 or 6 years of moderate to severe alcohol abuse.

More than 30% of people hospitalized with any pancreatitis are alcoholics. However, only 5% of alcoholics get pancreatitis. Alcohol is a major cause of pancreatitis, but it is not clear why some people are more vulnerable to the toxic effects of alcohol on their pancreas than others.

If you had an episode of alcoholic pancreatitis, you are at a very high risk of having another one if you continue to drink. In vulnerable people, even a small amount of drinking can trigger a second attack of pancreatitis.

Difference between acute and chronic alcoholic pancreatitis

In medical terms, acute means something that happens within a short period of time, while chronic means something that lasts longer. Acute pancreatitis build up quickly and makes you very sick within a short period of time. Most alcoholics initially get acute pancreatitis. Usually, the acute alcoholic pancreatitis gets better with treatment, and eventually the pancreas returns to normal.

Some people resume drinking after getting better from an episode of acute alcoholic pancreatitis. They then may get another episode of acute pancreatitis. After a few repeated cycles of acute alcoholic pancreatitis, getting better, drinking again, and getting yet another episode of pancreatitis, they develop permanent changes in their pancreas. Their pancreas will have permanent calcium deposits that can be seen in a CAT scan. When that happens, they get chronic pancreatitis.

With chronic pancreatitis, there is not much active inflammation, as most digestive enzyme-producing cells are already dead or damaged. The pain of chronic alcoholic pancreatitis is not as severe as that of acute alcoholic pancreatitis, but it never really goes away. Chronic pancreatitis becomes a part of their lives. They may have times when pain gets really bad, requiring hospitalization. These episodes are now called acute exacerbations of chronic alcoholic pancreatitis. People with chronic alcoholic pancreatitis also have problems digesting their food because of the lack of digestive enzymes.

When you need to be hospitalized for alcoholic pancreatitis

Acute alcoholic pancreatitis can be a deadly condition. Overall, 20% of people hospitalized with acute pancreatitis don’t make it. The death rate among people with acute alcoholic pancreatitis varies significantly based on the severity of the disease. People with mild acute alcoholic pancreatitis may have a death rate as low as 2%, while others with severe acute pancreatitis may have a death rate as high as 45%.

If you drink too much alcohol and have any of the following symptoms, you need to go to the nearest ER to get evaluated for possible acute pancreatitis.

Here are the symptoms:

  1. Severe pain in the middle of the belly that goes to your back and also radiates out to your sides in a belt-like fashion
  2. Nausea and vomiting with the belly pain
  3. Feeling dizzy and lightheaded with the belly pain
  4. Very sensitive and tender belly with pain when you touch or press it
  5. Belly pain worsening significantly when you try to eat or drink anything

In the ER, you will get some blood work and possibly a CT scan of your belly. If you have acute alcoholic pancreatitis with significant pain, you will most likely get hospitalized for treatment.

What to expect when hospitalized for acute alcoholic pancreatitis

Once a decision has been made to get you hospitalized for acute alcoholic pancreatitis, they will estimate its severity.

If you have one or more of the following, you may have severe alcoholic pancreatitis, and may need to go to the ICU:

  1. Low blood pressure
  2. Very high WBC count
  3. Significant shortness of breath with low oxygen levels
  4. Kidney failure
  5. Very low calcium levels in the blood

The treatment of acute alcoholic pancreatitis in hospital is focused on three things:

  1. Treatment of pancreatitis
  2. Treatment of alcohol withdrawal
  3. Treatment of other alcohol-related medical problems

There is no special treatment for acute alcoholic pancreatitis. You will be simply monitored for possible complications. You will not get any food or drink until your pain improves. Any food or drink may signal your pancreas to produce more digestive enzymes. Those enzymes may leak out and make things worse. They will support you with IV fluids while you are not eating or drinking. With rest, the inflammation in the pancreas slowly goes down, and most patients with mild alcohol pancreatitis eventually get back to normal.

If you have severe acute alcoholic pancreatitis, your outlook may not be that great. You may need to be placed on a ventilator if your oxygen goes down. They will give you lots of IV fluids to help bring your blood pressure up. You may need dialysis for kidney failure. Despite treatment, some patients still don’t make it. The death rate increases if you also have liver failure and other problems related to alcohol abuse.

Many patients with acute alcoholic pancreatitis are habitual drinkers. They go into different degrees of alcohol withdrawal while hospitalized. Severe alcohol withdraw may cause seizures and could be life-threatening. The treatment of patients hospitalized with acute alcoholic pancreatitis includes monitoring and treating alcohol withdrawal symptoms and other alcohol-related medical problems.

In conclusion, alcoholic pancreatitis is a serious condition that could be life-threatening. There are no medications to treat acute alcoholic pancreatitis. You may need hospitalization and close monitoring for possible complications. Stop drinking alcohol if you had an episode of alcoholic pancreatitis.