Pancreatitis therapy

Acute pancreatitis is a very serious illness that doctors usually treat in hospital, often even in the intensive care unit. This also applies to people with chronic pancreatitis who have a disease flare-up - the inflammation then flares up again.

Treatment options

The following treatment options are available for pancreatitis:

  • Mild pancreatitis: Under conservative treatment with painkillers, mild pancreatitis, which is the most common type (80%), heals completely within a few days. As a rule, no special diagnostic and therapeutic interventions are required. However, it is important to find the cause of the pancreatitis. The most common causes are alcohol and gallstones. Other less common causes may be hyperlipidemia or a pancreatic tumor. However, if gallstones are the cause of mild pancreatitis, the gallbladder as the reservoir for the gallstones must be removed in order to prevent further inflammation. This operation is performed laparoscopically once the acute inflammatory reaction has subsided. However, it may also be carried out during the same inpatient stay.
  • Severe pancreatitis: Patients with severe pancreatitis often require intensive medical treatment to monitor and treat the various organ dysfunctions. Repeated X-ray and laboratory examinations, antibiotics and artificial nutrition are necessary. If gallstones are the cause, an ERCP examination is performed. The pancreatic tissue destroyed by the inflammation has a high infection rate. This infected tissue can be the starting point for sepsis, so that it must be removed by surgery (“necrosectomy”). Despite the best possible treatment methods available today, patients can still die from severe acute pancreatitis.

    Computer tomography (CT) of severe necrotizing pancreatitis

    Computer tomography (CT) of severe necrotizing pancreatitis

  • Conservative therapy: Chronic pancreatitis is mainly treated with conservative medication. The most important measure is to give up alcohol and tobacco completely. As practically all patients, without exception, experience severe to very severe pain, good and adequate pain therapy is of great importance. Blood sugar control and the replacement of digestive enzymes with medication are further therapeutic approaches.

    Computer tomography (CT) of chronic calcifying pancreatitis

    Computer tomography (CT) of chronic calcifying pancreatitis

  • Surgical therapy: As a result of the increasing scarring of the pancreas, the common bile duct and the pancreatic duct as well as the duodenum (duodenum) can become narrowed. In these cases, Whipple surgery or a duodenum-preserving pancreatic head resection may be necessary. If large cysts have formed in the pancreas as a result of repeated episodes of inflammation, these can be drained by drainage surgery, as can an isolated blocked pancreatic duct.

Acute pancreatitis - nutrition tips

You can – often after just a few days – gradually eat foods that are easy to digest again. This way you don’t overload your pancreas.

  • Choose foods that are as low in fat as possible: dairy products such as cheese, yoghurt, quark or milk as well as sausages are also available in low-fat varieties.
  • Cook with less fat: steaming, baking or steaming are better than frying or deep-frying when preparing food.
  • It is better not to eat fruit and vegetables raw, but to steam or boil them. This makes it easier to digest.
  • Do not cook with hot spices (pepper, chili) and do not eat spicy food.
  • Eat several small portions a day instead of a few large meals.
  • It is better to avoid very hot or very cold food.
  • Choose drinks such as still water, tea or spritzers made from fruit or vegetable juices. It is better to leave out drinks with a high sugar content such as iced tea, cola, lemonade or soft drinks.
  • It is better to skip coffee at the beginning, and later only enjoy it in moderation. Milk also needs to be used sparingly.
  • And for alcohol: avoid it altogether.

Once the pancreatitis has completely healed, you can eat a normal – i.e. healthy and balanced – diet again.

Nutrition for chronic pancreatitis - tips

The same general rule applies here: Eat as healthy and balanced a diet as possible in the long term. Include lots of different foods in your diet. You should also not smoke or drink alcohol. Some tips on nutrition:

  • Choose easily digestible foods: e.g. potatoes, rice, bread, pasta, vegetables, fruit (both preferably cooked or steamed).
  • The diet should contain plenty of carbohydrates.
  • Do not consume more than 50 to 80 grams of fat per day.
  • Eat several smaller meals throughout the day instead of a few large portions.
  • Avoid foods that are difficult to digest, e.g. pulses (lentils, beans, peas), fried foods, deep-fried foods, cold drinks and food.

Chronic pancreatitis: medication and dietary supplements

In chronic pancreatitis, the gland no longer produces sufficient amounts of digestive enzymes. However, these are necessary in order to break down the food. In this case, enzyme preparations that take over this task can help. In addition, there is often a vitamin deficiency. For example, patients lack vitamins A, D, E, K, vitamin B12, vitamin B1 or folic acid. Talk to your doctor about whether dietary supplements make sense in your case.

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Responsible doctors

Henrik Petrowsky, Prof. Dr. med.

Senior Attending Physician, Department of Visceral Surgery and Transplantation

Tel. +41 44 255 97 05
Specialties: Hepatobiliary & pancreatic surgery (HPB surgery), Liver transplant, Robotic Surgery

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