How is pancreatitis treated naturally

Pancreatitis: treatment

Acute inflammation of the pancreas

Nonsurgical treatment of acute pancreatitis and the relapse of chronic pancreatitis
For inflammation of the pancreas, there is as yet no treatment for the inflammation itself. It is therefore primarily the effects and complications of the disease that are treated. In addition, lifestyle changes can help patients avoid the triggers.

If the trigger is gallstone disease (biliary pancreatitis), not only are any bile duct stones - as described above - immediately removed endoscopically, but the gallbladder must also be surgically removed. This is usually done using the keyhole technique (laparoscopic cholecystectomy) after the pancreatitis has subsided. The gallbladder is not removed in parallel with acute pancreatitis due to the increased surgical risk. The operation, i.e. the rehabilitation of the biliary tract, should still be carried out during the inpatient stay, since a severe relapse of pancreatitis can occur after discharge and postponement of the operation to a later date.

Acute inflammation of the pancreas is treated in the hospital, in severe cases in the intensive care unit.

In severe pancreatitis, there is extensive fluid loss in the back of the abdomen (retroperitoneum). In order to maintain the circulation and, among other things, to prevent kidney failure, the extent of the loss of fluid must be measured and then adequately compensated for with electrolyte solutions or, if necessary, blood transfusions. The prevention and eventual therapy of the failure of the function of vital organs is a great challenge for intensive care medicine.

If the pain is severe, the internist will administer antispasmodic medication and pain relievers. Since the drugs often have to be taken in high doses, they can cause dizziness, light-headedness, nausea and difficulty breathing.

To relieve the pancreas, patients should not eat food for some time. In the case of a slight inflammation, 2-5 days are usually sufficient. It may be necessary to aspirate gastric juice through a tube.

Nutrition and further hydration are provided via a small intestine tube.

The gradual diet, initially with tea and rusks, depends on the clinic and the wishes of the patient - not on laboratory parameters. A diet is allowed if the patient tolerates it without abdominal pain, even if the serum lipase is still elevated. Of course, alcohol-induced pancreatitis must be avoided for life. The fat intake should be restricted for the time being, even if it is tolerated.

With necrotizing pancreatitis there is a risk of infection of the dead tissue (the necrosis). Unfortunately, this cannot be prevented by administering prophylactic antibiotics. Antibiotic therapy is only given if the infection is proven.

The breakdown of the necrosis by the immune system's own cells can take a very long time, i.e. weeks to months. If the symptoms do not improve significantly and the extent of the necrosis detected in the CT does not decrease, these must be removed. In the past, this was only done operationally. Today the therapy depends on the anatomical position of the necrosis. They can be punctured and drained using CT (i.e. "drained" by removing tissue fluid). Surgical endoscopic access “from behind” into the posterior abdominal cavity (the so-called retroperitoneum) is possible. Very often, however, endoscopic access through the posterior wall of the stomach is also possible. As part of a gastroscopy, the posterior wall is punctured and drains (i.e. drains for fluids) are placed in the necroses. The necroses can be removed endoscopically with special instruments in several sessions. The endoscopically placed defect of the gastric posterior wall closes spontaneously after removal of the necrosis and drainage.

Chronic pancreatitis

Nonsurgical therapy for chronic pancreatitis

The main symptom of chronic pancreatitis is recurring (recurrent) or persistent pain of varying severity. Since the pain can have various causes, diagnostic imaging is necessary to determine the type of pain therapy: medication or interventional endoscopy or surgery.

Drug pain therapy is based on the grading scheme proposed by the World Health Organization (WHO) for chronic pain.
It is crucial for the success of the treatment that the patient abstains from alcohol and nicotine for their entire life. As a rule, symptoms of chronic pancreatitis subside as soon as the patient eats less. They must also take digestive enzymes with every meal to make up for the decreased production of digestive enzymes. This treatment of the above-mentioned exocrine insufficiency is carried out with extracts from the pancreas of pigs. They are given with meals. The effect of these enzymes can be increased if the acid secretion of the stomach is inhibited by so-called proton pump blockers. If it is not possible to decisively improve fat digestion, the fat-soluble vitamins A, D, E, K must also be administered in order to avoid a deficiency of these necessary vitamins.

If the pancreas does not produce enough insulin, patients have to compensate for the insulin deficiency with insulin injections. You should be examined regularly by your internist.

The internist treats severe relapses in a similar way to acute inflammation (see above).
Larger so-called pseudocysts (inflammatory enlargements of the pancreatic head) are emptied through a drain into the stomach or intestines. The internist can also use endoscopy to stretch constrictions in the pancreas and bile ducts and bridge them with prostheses.

Surgical therapy

If these treatment methods do not help, an operation is an alternative. In this way, the surgeon can reduce the pressure in the pancreas and thus also the pain when the ducts are narrowed. To do this, he creates an artificial connection between the small intestine and the enlarged pancreatic duct (drainage). The last resort (ultima ratio) is the operative, partial or complete removal of the pancreas.