Alex, a 30-year-old attorney and self-described fitness nut, was deeply frustrated. He had come to me for an evaluation after his third episode of acute pancreatitis. Each of the episodes had been intensely painful and landed him in the hospital for several days, where he hadn’t been allowed to eat anything and had received copious painkillers. Internists hadn’t found anything so far, so I had been asked by his referring doctors to look deeper to find a cause.
While most people think their stomach digests their food, in reality, the pancreas does most of this work. This organ sits behind the stomach and just in front of the spine, and is connected to the small intestine via several fine ducts. In addition to sodium bicarbonate (which the body uses to neutralize stomach acid), the pancreas makes digestive enzymes that break down carbohydrates, fats and proteins into small components that can then be absorbed into the bloodstream through the small intestine.
Pancreatitis, as the name suggests, refers to inflammation of the pancreas itself. Attacks of pancreatitis vary widely in severity and can sometimes be fatal. Even mild pancreatitis can be excruciatingly painful. Alex was lucky that he had recovered from his initial attacks, but he lived in constant fear of another one.
Most episodes of pancreatitis are caused by gallstones that migrate out of the gallbladder (where they initially form) and into the main bile duct, which drains bile from the liver. The bile duct and the pancreatic ducts eventually meet, and when stones get stuck at this location, pancreatitis often ensues.
However, Alex had had his gallbladder surgically removed years ago. He also didn’t drink alcohol, which was key because many people develop pancreatitis secondary to alcohol use or abuse. Many medications can cause pancreatitis as a side effect, but Alex had never taken any of them. Additional blood tests didn’t indicate any metabolic problems that could make him more at risk for pancreatitis. I also checked him for rare genetic causes of pancreatitis, but all the tests came back negative.
