The pancreas is an important gland for digestion and blood sugar regulation. It can become inflamed, causing acute or chronic pancreatitis. Acute attacks of pancreatitis can be deadly and require emergency medical attention. Chronic pancreatitis may eventually lead to pancreatic cancer, one of the most aggressive and deadly of all types of cancer.
There are many risk factors involved in these diseases of the pancreas and one of them is medication. Medications, like Depakote, an anti-seizure drug, can trigger acute pancreatitis or contribute to chronic pancreatitis. Most recently, type 2 diabetes drugs have been implicated in increasing the risk that a patient will develop pancreatitis or pancreatic cancer.
The Role of the Pancreas
The pancreas is a large gland that sits behind the stomach and near the upper portion of the small intestines. It has two main functions: to aid digestion and to produce and excrete hormones that regulate blood sugar levels. To promote digestion the pancreas produces enzymes, which it releases into the pancreatic duct and ultimately into the small intestines. These enzymes break down proteins, carbohydrates, and fats.
The pancreas also produces two important hormones to regulate blood sugar. Insulin is produced and released from the pancreas when blood sugar levels are too high. The pancreas makes and releases glucagon when blood sugar is low. Together these hormones balance each other and keep blood sugar levels in the body stable. When something goes wrong with insulin, it can result the chronically high blood sugar levels associated with diabetes.
What is Pancreatitis?
Pancreatitis is inflammation in the pancreas. This condition can be mild and will resolve itself without treatment, but it can also be severe and life-threatening. Pancreatitis can also be chronic or acute. The latter is more common, comes on suddenly and can be deadly. It may require emergency medical treatment. Chronic pancreatitis is a long-lasting type of inflammation that can significantly reduce quality of life.
Pancreatitis can have many different causes and having multiple incidents of acute pancreatitis can lead to a chronic condition. Alcoholism, smoking, genetics, high levels of calcium, physical injury, infections, high triglyceride levels, surgery, gallstones, and certain medications can all cause or contribute to pancreatitis.
There are also several complications that can result from pancreatitis, especially if it is not successfully treated to bring down the inflammation. These include malnutrition, diabetes, infections, kidney failure, the formations of cysts in the pancreas, which can burst and cause internal bleeding and infections, difficulty breathing, and pancreatic cancer.
Symptoms and Treatment for Pancreatitis
Acute pancreatitis comes on suddenly and may cause symptoms like a fever, pain in the upper abdomen, pain that radiates into the back, and abdominal pain that gets worse after eating. Acute attacks may also cause vomiting and nausea. Chronic pancreatitis causes upper abdominal pain as well, but it may come and go and be less severe. It also causes weight loss, and stools that are oily and smelly.
Pancreatitis can be diagnosed by checking the blood for elevated levels of certain enzymes and imaging techniques to look at the pancreas and gallbladder. Sudden attacks of pancreatitis are usually treated by fasting, using pain medications and intravenous fluids. These measures can bring an attack under control so that doctors can treat whatever is causing the attack. Treatment for acute pancreatitis is administered in the hospital over the course of a few days.
Treatment may include surgery to remove gallstones or other obstructions that are causing the inflammation or to remove fluid or damaged tissue from the pancreas. Other treatments may include addressing alcoholism, quitting smoking, or using diet or medications to lower triglyceride or calcium levels or to treat an infection.
For someone with chronic pancreatitis, the condition may last for years or indefinitely, which means ongoing treatments. These include pain management, using medications or other strategies to reduce severe pain, supplementing with enzymes to help improve digestion, and changing the diet to make digestion easier and to ensure proper nutrition.
Pancreatic cancer is the growth of malignant cells that originate in the pancreas. The prognosis for pancreatic cancer is often poor. Even an early diagnosis for this kind of cancer does not usually come with a good prognosis. Pancreatic cancer is often terminal because it spreads very rapidly. It is also difficult to diagnose in the early stages. Because the pancreas is situated deep in the abdominal cavity, surrounded by other organs, it is difficult to palpate, or feel, tumors. Furthermore, the symptoms of this kind of cancer don’t usually appear until it is advanced.
Although they are not often felt until the cancer is in a later stage, there are some distinct signs of pancreatic cancer. These include loss of appetite and weight loss, pain in the upper abdomen radiating into the back, jaundice, which is the yellowing of the skin and the whites of the eyes, depression, and the formation of blood clots.
Definitive causes of pancreatic cancer are usually not known, but there are risk factors that make people more susceptible to developing it. These include smoking, being overweight or obese, having a family history of pancreatic cancer, having diabetes, pancreatitis, and having certain genes. Pancreatic cancer is diagnosed by imaging the pancreas and taking biopsies to be examined for cancer cells. Treatment may include any combination of surgery, chemotherapy, and radiation. For most patients these are not curative, but may reduce the tumor size and extend life. Treatment is also used for palliative care, to make end-stage patients more comfortable.
The Connection between Pancreatitis and Cancer
Pancreatitis by itself is an uncomfortable, and in the case of acute attacks, potentially deadly condition. Unfortunately suffering with chronic pancreatitis can also be a risk factor for pancreatic cancer. Smoking while also having chronic pancreatitis increases this risk significantly. In some patients there may be genetic factors underlying and causing both conditions. It is also possible that symptoms will overlap and that someone with pancreatic cancer will be misdiagnosed as having chronic pancreatitis.
There is also some research that suggests acute pancreatitis may be a warning sign or a symptom of underlying pancreatic cancer. Researchers found that patients treated for acute pancreatitis were more likely to later be diagnosed with pancreatic cancer. They also discovered that if patients with acute attacks were screened for cancer, a delayed diagnosis of pancreatic cancer could be avoided, giving a patient a better chance at benefiting from treatments.
Type 2 Diabetes Drugs Damage the Pancreas
The number of diagnoses being made for type 2 diabetes is on the rise. This condition occurs when the body loses its sensitivity to the insulin produced by the pancreas, which in turn results in high blood sugar levels that can have serious health complications. Many people can control their diabetes with changes in diet and exercise and with weight loss, but many will also need to take a medication that supports those efforts and lowers blood sugar.
Many of these drugs act in the pancreas, to boost production of insulin or to help the body react to it more, but these actions can have serious consequences for the pancreas. Several drugs used to treat type 2 diabetes now carry warnings that they may increase the risk of a patient developing pancreatitis or even pancreatic cancer.
An example is the drug Byetta, made by Bristol Myers Squibb. It belongs to a class of drugs called incretin mimetics. It works to treat type 2 diabetes by stimulating the pancreas to produce and release more insulin. Since an initial warning by the FDA in 2007 that Byetta could cause pancreatitis and pancreatic cancer, the research evidence has continued to grow showing that this drug has serious and harmful potential side effects. The current recommendation is that anyone with a history of any type of pancreas problem should not use this drug. Bristol Myers Squibb is facing lawsuits over these side effects from plaintiffs who accuse the company of not warning them of these serious risks.
Other Dangerous Drugs That Affect the Pancreas
Byetta is just one example of drugs that can be dangerous because of the effects on the pancreas. Other type 2 diabetes drugs that show evidence of increasing the risk of pancreatitis or pancreatic cancer include Bydureon, Glyxambi, Januvia, Janumet, Nesina, Oseni, Kazano, Tradjenta, Jentadueto, and Victoza. The risks of pancreas damage with these drugs must always be weighed against the benefits of lowering blood sugar.
Other types of drugs may also put people at risk of pancreatitis and pancreatic cancer. For example, Depakote, an anticonvulsant used to treat seizure disorders, includes a black box warning on its label for the risk of pancreatitis. Other drugs that may trigger dangerous acute pancreatitis include immunosuppressant drugs used in organ transplants, certain diuretics and anti-inflammatory drugs, and tetracycline, an antibiotic.
Pancreatitis and pancreatic cancer are very serious illnesses that affect an important gland in the body. In addition to natural or unknown causes, there are several medications that put patients at risk of developing these conditions. Type 2 diabetes drugs are especially implicated, but all medications that could affect the pancreas should be carefully weighed for benefits versus risks.