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Understanding and Managing Pancreatitis: A Guide for Patients

Pancreatitis is a complex condition, and depending on the cause, treatment can vary. In the rest of this guide, you'll learn more about how you can manage pancreatitis including:

    • How genetics plays a role in pancreatitis
    • How genetics affects your treatment
    • Ways to cope with pancreatitis
    • Ways to advocate for yourself and more

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Understanding and
Managing Pancreatitis

A Guide for Patients

Without a pancreas, you cannot completely digest food, which would leave you malnourished. Additionally, since the pancreas regulates blood sugar, you would have diabetes without one.

A properly functioning pancreas creates digestive enzymes, which are made and released in an inactive, harmless form into the small intestine where the process of digestion begins.

Pancreatitis occurs when these enzymes become activated before leaving the pancreas, essentially beginning to digest the organ and causing inflammation. The condition can be acute or chronic and leave you suffering from bouts of severe abdominal pain, negatively impacting your quality of life. In this guide, we’ll look at the basics of pancreatitis, how genetics can play a role in it and how genetics may influence your treatment options, strategies to cope and more.

The pancreas is an organ located behind the stomach and it provides two critical functions for your body:

  • It makes and releases digestive enzymes to break down food in your digestive tract
  • It regulates your blood sugar by releasing insulin and other hormones.
your-body

What is Pancreatitis?

SYMPTOMS & CAUSES

Acute versus Chronic Pancreatitis

Pancreatitis can either be acute or chronic. Acute pancreatitis occurs suddenly. Patients with acute pancreatitis typically present with severe abdominal pain and usually require emergency medical treatment. Some people who have had one attack of acute pancreatitis can go on to have several more attacks. This is called recurrent acute pancreatitis. Recurrent attacks of acute pancreatitis can lead to chronic pancreatitis.

Chronic pancreatitis is a long-lasting condition where the health of the pancreas worsens over time. Patients with chronic pancreatitis may have chronic pain, trouble digesting their food, and can develop diabetes. It is diagnosed by imaging studies that show specific changes to the pancreas.

Symptoms of Pancreatitis

Symptoms of pancreatitis can vary widely from patient to patient.

ACUTE PANCREATITIS

  • Sudden severe upper abdominal pain that may radiate to your back and/or feel worse after eating
  • Fever
  • Nausea, vomiting
  • Abdominal tenderness

CHRONIC PANCREATITIS

  • Upper abdominal pain, which may be constant or episodic
  • Unintentional weight loss
  • Oily, smelly stools that may or may not be diarrhea

What Causes Pancreatitis?

There are several causes of pancreatitis, as well as certain factors that can increase your risk of developing the condition:

RISK FACTORS

  • Being male
  • Being African American
  • Having a family history of pancreatitis
  • Having a personal or family history of gallstones
  • Smoking
  • Heavy alcohol use
  • Hereditary genetic disorders of the pancreas
  • Cystic fibrosis
  • Combinations of common genetic risk factors

CONTRIBUTING FACTORS

  • Diabetes
  • Gallstones
  • High triglycerides 
  • Traumatic injury to the pancreas
  • Certain medications
  • Pancreatic cancer

Treatment Options

FOR PANCREATITIS

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), treatment for acute and chronic pancreatitis can include:

Treatment to address dehydration

Pain
medication

Antibiotics to address infection

(If you have one)

A low-fat diet or nutrition

(Via a feeding tube or IV if you’re unable to eat)

Pain Relief Treatment

Treatment for chronic pancreatitis is aimed at relieving pain, improving the function of the pancreas and managing complications. This can include:

Medications

Medications and Vitamins

You may need additional vitamins if you have issues with absorbing your food. You may also receive enzymes to help with digestion.
diabetes

TREATMENT FOR DIABETES

Chronic pancreatitis may cause diabetes. If you develop the condition, your medical team will help you monitor and treat it.
procedures

SURGERY AND PROCEDURES

You may have surgery to relieve pressure or a blockage in a pancreatic duct or to remove a portion of your pancreas if it is damaged or infected. Some patients who do not improve with other treatments have their pancreas removed, followed by islet cell auto-transplantation, which can help preserve some of the ability to regulate blood sugar without a pancreas.
Your doctor may also suggest a nerve block for pain management.

How Genetics Play a Role

IN PANCREATITIS

Hereditary Pancreatitis

While some attacks of pancreatitis are the result of medication and other risk factors, pancreatitis can be hereditary. Hereditary pancreatitis is a genetic condition characterized by recurrent episodes of pancreatitis that is typically inherited from a parent.

Symptoms of hereditary pancreatitis can begin in childhood with an acute attack that progresses to recurrent acute attacks. These episodes of recurrent inflammation lead to chronic pancreatitis.

Hereditary Pancreatitis Complications

Pancreatic Fibrosis

Years of ongoing inflammation from hereditary pancreatitis can cause fibrosis — the formation of scar tissue — in place of functioning pancreatic tissue, which leads to loss of pancreatic function.

Pancreatic Cancer

Chronic pancreatic inflammation can increase your risk of developing pancreatic cancer. Your risk for pancreatic cancer increases if you also smoke, have a family history of cancer, use alcohol or have Type 1 diabetes, according to the U.S. National Library of Medicine.

For most people with hereditary pancreatitis, a pathogenic - or harmful - genetic variant in the PRSS1 gene is responsible for the development of the condition. The PRSS1 gene gives instructions for making an enzyme called cationic trypsinogen, which aids in the digestion of food. Typically, cationic trypsinogen is released from the pancreas and travels to the small intestine where it enters its active form called trypsin. However, in patients with a pathogenic variant in the PRSS1 gene, cationic trypsinogen is converted into trypsin while still in the pancreas, resulting in damage to pancreatic tissue.

Around 60% to 80% of patients with hereditary pancreatitis have a pathogenic variant in the PRSS1 gene. Other patients with hereditary pancreatitis may have variants in the CTRC or SPINK1 genes and still others can have variants in genes that have yet to be identified.

Chronic Pancreatitis

Episodes of acute and chronic pancreatitis can be linked to genetic variants. Idiopathic - or unexplained - chronic pancreatitis is thought to be a complex disorder — meaning multiple variants in multiple genes are suspected to cause the disease in combination with environmental factors. Genetic variants in the CTFR and SPINK1 genes can predispose to the condition, but other genes can also contribute to developing it. In contrast with monogenic disorders, such as hereditary pancreatitis (caused by a high-impact variant in a single gene), people with idiopathic chronic pancreatitis often have several harmful lower-impact variants in multiple genes.

More About Polygenic Causes of Pancreatitis

For many patients, more than one gene is involved in the development of their pancreatitis. These patients have what is known as a complex disease. Up to 95% of pancreatitis cases are not caused by monogenic hereditary disorders.

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Keep in Mind...

It’s important to note that having a harmful genetic variant does not guarantee a person will experience symptoms. Lifestyle choices, environmental factors, and other genetic factors — some protective — can also contribute to whether someone with a genetic predisposition will develop a disease.

How Genetics Influences
Pancreatitis Treatment

If you have chronic pancreatitis, have had an attack of acute pancreatitis or have a family member with the condition, you may be wondering how genetics influences disease onset, progression and treatment.

Knowing which genetic variant or variants are causing your condition can help your care team tailor your treatment. Genetic testing, combined with your medical and family history, can help reduce unnecessary testing, procedures and medication.

Should My Family or I Get Tested?

Genetic testing can help you make informed decisions about your care. Consider genetic testing for pancreatic diseases if you:

  • Have acute or chronic pancreatitis of an unknown cause
  • Had an early age of onset — 35 years old or younger — of pancreatitis
  • Have a family history of chronic pancreatitis, acute or recurrent acute pancreatitis, or childhood pancreatitis involving a first- or second-degree relative
  • Are an at-risk family member of someone who has an identified pathogenic genetic variant associated with hereditary pancreatitis
  • Want to identify the cause of your pancreatitis or are simply seeking more information about the progression of your disease

Which Genetic Tests for Pancreatitis Should I Use?

There are a range of genetic variants that contribute to pancreatic diseases like pancreatitis, and if you’re considering genetic testing, you’re probably wondering which genes you should test for. 

Before you get tested, however, you should consider genetic counseling to help you understand which test is appropriate, what the results could mean and where to get more resources.

Genetic-Tests

How Doctors Can Use Genetic Information for Treatment

If you’re dealing with a complex chronic pancreatic disease like pancreatitis or cancer, you’re probably wondering:

  • Why did this happen to me? 
  • What’s going to happen to me in the future?
  • Is there anything I can do to reduce or stop disease progression and/or symptoms?

The information from your genetic tests, combined with your clinical history, can give your physician insight into why you developed your disease, how it might progress and what can be done to potentially limit its progression/reduce symptoms. It can also help reduce time to diagnosis and let your physician know if the treatments they’re using for your disease are effective.

 

Strategies to Cope

with PANCREATITIS

Diet

A change in your diet can help ease pain and reduce pancreatitis attacks. Here are some common dietary tips that can help you manage your disease. Always consult your doctor or dietitian for dietary advice for managing your pancreatitis. 

During a flare of symptoms, your doctor or healthcare team may advise you not to eat or drink for a short period. Once you’re able to eat and drink again, you may be told to stick to a healthy, low-fat eating plan that includes small, frequent meals and to avoid alcohol and caffeine. 

For chronic pancreatitis, it is commonly recommended that you:

Eat four to six small meals per day

Spread your fat intake throughout the day

Grill, bake, roast or steam foods

Include a healthy mix of fruits, vegetables, whole grains, protein and low-fat or fat-free dairy in your diet daily

Advocating for Yourself

While it may seem there’s not much you can do about short appointment times or a busy physician, there are things you can do to advocate for yourself and strengthen your doctor-patient relationship the next time you visit the doctor.

Prepare for your appointment

Preparing for your appointment allows you to specify what you want to discuss and what questions you have. It can be helpful to make a list of your concerns, symptoms and questions ahead of time to ensure you don’t forget anything you’d like to talk about. Creating a list allows your healthcare team to make the most of the time they have with you by focusing on your most pressing concerns.

Ask questions

If your doctor writes you a new prescription or orders a test — or if you don’t understand what your doctor tells you — ask questions. Ask what the prescription or test is for, if there are any side effects that you should watch for and why they are prescribing it. 

Also, ask if there is anything you need to do to prepare for the test or if there are any specific instructions you should follow when taking the medication. If you’re receiving a test, don’t forget to ask when the test results will be ready and how they will communicate them to you.

If you receive a new diagnosis, ask your doctor if your condition is chronic or can be cured, where you can learn more information about it and how it can be treated or managed.

Ask for another appointment, if needed

You can be well prepared, but time limits on appointments can still leave you with unaddressed concerns. If you have additional needs, don’t forget to ask for a follow-up appointment.

Bring someone with you

If you’re dealing with a complex or chronic condition and seeing multiple providers, the person you bring with you can help you remember each treatment you’re receiving or medications you’re taking. They can also help take notes and ask questions about the next steps and a treatment plan.

Know when to seek a second opinion or find a new doctor

A strong doctor-patient relationship is a partnership, but if you feel like you don’t work well together, consider finding a new physician. If your doctor doesn’t take the time to listen and answer your questions, doesn’t explain why they recommend treatments, frequently interrupts you, disrespects you or you don’t feel comfortable disclosing important details of your condition, you should end the relationship.

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A NEW APPROACH For

Managing Complex
Chronic Diseases

In the past, physicians and scientists relied on looking at single factors for disease development and progression. This did very little to provide insight into disease progression and did not provide a complete picture of what the patient was experiencing.

A new approach is now available. Precision medicine uses the latest scientific research, clinical features and genetics to tie everything together to find out what’s going on with an individual patient. 

Ariel Precision Medicine’s technology focuses on complex genetics that interface with familial and environmental factors to provide you and your healthcare team with a more comprehensive view of your disease trajectory and precise therapeutic options.

Talk to your doctor today about how Ariel’s PancreasDx test can help you better understand and manage your pancreatitis.

Talk to your doctor today about how Ariel’s PancreasDx® test can help you better understand and manage your pancreatitis.

PancreasDx: Go Beyond Genetics for Managing Recurrent Acute and Chronic Pancreatitis

How does PancreasDx work?

Who should get tested?

What kind of genetic testing technology do you use?

Is my information protected?

Which genes does PancreasDx test for?

What if I need additional testing?

What if I have more questions or need additional information?