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What Causes Recurrent Pancreatitis?
Question: Hi! My mother has been suffering from acute pancreatitis since March 2015. Her first attack
was quite severe and that time some biliary sludge was found, but apart from that the doctor could not find a concrete reason. There was also a small polyp in her gall bladder. The second attack happened in July 2016 and it was mild. That time too, no reason was found and she was asked to maintain dietary restrictions which she did as much as possible. Her third attack happened yesterday, which was milder than the last one (Amylase - 339 and Lipase - about 3000).
She did not have to get admitted to the hospital this time and we got it under control at home itself. Her doctor today has said that he wants to get some specific tests done for genetic mutation or pancreatic divisum etc. My grandfather died of leukaemia and one of my mother's aunts succumbed to breast cancer. Does that put her under any risk?
Additionally, my mother also suffers from hyperparathyroidism, hyperthyroidism, hypertension and is also undergoing treatment for endometrial hyperplasia (which happened later in the same year as her first pancreatitis attack).
We are unable to figure out how to control this unpredictable disease and are also very worried about this progressing to a worse condition. Please advise!
Thank you!
was quite severe and that time some biliary sludge was found, but apart from that the doctor could not find a concrete reason. There was also a small polyp in her gall bladder. The second attack happened in July 2016 and it was mild. That time too, no reason was found and she was asked to maintain dietary restrictions which she did as much as possible. Her third attack happened yesterday, which was milder than the last one (Amylase - 339 and Lipase - about 3000).
She did not have to get admitted to the hospital this time and we got it under control at home itself. Her doctor today has said that he wants to get some specific tests done for genetic mutation or pancreatic divisum etc. My grandfather died of leukaemia and one of my mother's aunts succumbed to breast cancer. Does that put her under any risk?
Additionally, my mother also suffers from hyperparathyroidism, hyperthyroidism, hypertension and is also undergoing treatment for endometrial hyperplasia (which happened later in the same year as her first pancreatitis attack).
We are unable to figure out how to control this unpredictable disease and are also very worried about this progressing to a worse condition. Please advise!
Thank you!
Brief Answer:
Recurrent pancreatitis in her may be due to billiary sludge
Detailed Answer:
Hello! Thanks for putting your query in HCM. I am a Gastroenterologist. I have read your query throughly and I can understand your concerns
There can be few reasons for recurrent pancreatitis in your mother:
1. Billiary pancreatitis- as some sludge was seen during forst attack. So I will advise her to get cholecystectomy that is surgery for gallbladder removal as it can be the cause of recurrent pancreatitis in your mother
2. Tab Meprate which contains medroxyprogesterone may be cause as it causes hypertriglyceridemia which may lead to pancreatitis. Sop you may ask her doctor to check triglyceride levels
3. Hyperparathyroidism itself as it causes hypercalcemia which can be checked with serum calcium levels
4. Apart from the above other are genetic and congenital abnormalities of pancreas and pancreatic duct which your doctor have discussed with you. For which genetic tests and MRCP (MRI) is required.
I will suggest her to get cholecystectomy after discussion with your doctor and see for the second and third cause as I have discussed above. If still there is further attack then go for genetic tests also.
Leukaemia and breast cancer in first degree relative increases the risk of the same disease but not pancreatitis. But till now they are not there then there is nothing to worry. However screening for cancer is advisable
Hope I addressed all the concerns you have. Let me know if you have further questions. I will be more than happy to clear any doubts. Wish her a good health
Recurrent pancreatitis in her may be due to billiary sludge
Detailed Answer:
Hello! Thanks for putting your query in HCM. I am a Gastroenterologist. I have read your query throughly and I can understand your concerns
There can be few reasons for recurrent pancreatitis in your mother:
1. Billiary pancreatitis- as some sludge was seen during forst attack. So I will advise her to get cholecystectomy that is surgery for gallbladder removal as it can be the cause of recurrent pancreatitis in your mother
2. Tab Meprate which contains medroxyprogesterone may be cause as it causes hypertriglyceridemia which may lead to pancreatitis. Sop you may ask her doctor to check triglyceride levels
3. Hyperparathyroidism itself as it causes hypercalcemia which can be checked with serum calcium levels
4. Apart from the above other are genetic and congenital abnormalities of pancreas and pancreatic duct which your doctor have discussed with you. For which genetic tests and MRCP (MRI) is required.
I will suggest her to get cholecystectomy after discussion with your doctor and see for the second and third cause as I have discussed above. If still there is further attack then go for genetic tests also.
Leukaemia and breast cancer in first degree relative increases the risk of the same disease but not pancreatitis. But till now they are not there then there is nothing to worry. However screening for cancer is advisable
Hope I addressed all the concerns you have. Let me know if you have further questions. I will be more than happy to clear any doubts. Wish her a good health
Above answer was peer-reviewed by :
Dr. Remy Koshy
Thank you for your insights, Dr. XXXXXXX
Both during the first and second attacks, she got MRCP done, and apart from inflammation in the pancreas, there was nothing else to be found. Everything else was normal. Triglyceride levels both times were normal and no presence of hypercalcemia was found either. Her C-reactive protein levels were also fine.
This is all the more reason why the doctors and we were all very confused as to why recurrent attacks were taking place. The first two times, we assumed it was due to some eating disorder and stress, both of which happened. However, this time, strict diet was maintained, though, for the last couple of days, my mother consumed dairy products frequently like cakes and milk tea, kheer etc. and yesterday too, she started feeling uneasy after eating a sweet in the morning. She has been forbidden to consume dairy products too much, so we thought that might be a reason as well as over-exertion and stress.
Also, ERCP has not been done yet because of its invasive nature which may put her at a risk of another attack. Do you still think that a screening for pancreatic cancer may be necessary?
Both during the first and second attacks, she got MRCP done, and apart from inflammation in the pancreas, there was nothing else to be found. Everything else was normal. Triglyceride levels both times were normal and no presence of hypercalcemia was found either. Her C-reactive protein levels were also fine.
This is all the more reason why the doctors and we were all very confused as to why recurrent attacks were taking place. The first two times, we assumed it was due to some eating disorder and stress, both of which happened. However, this time, strict diet was maintained, though, for the last couple of days, my mother consumed dairy products frequently like cakes and milk tea, kheer etc. and yesterday too, she started feeling uneasy after eating a sweet in the morning. She has been forbidden to consume dairy products too much, so we thought that might be a reason as well as over-exertion and stress.
Also, ERCP has not been done yet because of its invasive nature which may put her at a risk of another attack. Do you still think that a screening for pancreatic cancer may be necessary?
Brief Answer:
discuss with your doctor regarding cholecystectomy
Detailed Answer:
Welcome back
As triglyceride and calcium levels and MRCP was normal so these causes and congenital abnormalities of pancreas like pancreas divisum and pancreatic cancer are ruled out.
So the cause left is billiary sludge and genetic change.
So to confirm for the biliary sludge there is another test known as endoscopic ultrasound. If again slude is found she should undergo cholecystectomy. As Iit is also a common cause for recurrent pancreatitis. So as I suggest earlier also regarding cholecyatectom you should discuss with your doctor.
Stress and eating disorder usually dont lead to recurrent pancreatitis although low fat diet is advisable.
There is no indication of ERCP as suh so no need to undergo.
No need for screening for pancreatic cancer as MRCP was normal which is very sensitive test for pancreatic cancer.
So in my opinion disciss with your doctor for EUS and cholecystectomy
I hope I have answered your query. Wish her a good health
discuss with your doctor regarding cholecystectomy
Detailed Answer:
Welcome back
As triglyceride and calcium levels and MRCP was normal so these causes and congenital abnormalities of pancreas like pancreas divisum and pancreatic cancer are ruled out.
So the cause left is billiary sludge and genetic change.
So to confirm for the biliary sludge there is another test known as endoscopic ultrasound. If again slude is found she should undergo cholecystectomy. As Iit is also a common cause for recurrent pancreatitis. So as I suggest earlier also regarding cholecyatectom you should discuss with your doctor.
Stress and eating disorder usually dont lead to recurrent pancreatitis although low fat diet is advisable.
There is no indication of ERCP as suh so no need to undergo.
No need for screening for pancreatic cancer as MRCP was normal which is very sensitive test for pancreatic cancer.
So in my opinion disciss with your doctor for EUS and cholecystectomy
I hope I have answered your query. Wish her a good health
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Above answer was peer-reviewed by :
Dr. Nagamani Ng
Answered by
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