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Causes of Pancreatitis
Pancreatitis has a range of possible causes, including:
- Alcohol use
- Structural problems of the pancreatic and bile ducts
- Some medications like estrogen supplements and some diuretics
- Severe viral or bacterial infection
- Injury to the abdomen
- Elevated triglyceride levels, called hyperlipidemia
- Elevated calcium blood levels, called hypercalcemia
- Genetic causes such as gastric fibrosis
Causes of Acute Pancreatitis
Acute pancreatitis is most commonly caused by gallstones or heavy alcohol consumption. Other causes may include use of certain medications (such as immunosuppressants, estrogens, thiazide diuretics, and azathioprine), lipid (triglyceride) disorders, infections, surgery, or trauma to the abdomen from an accident or injury. Acute pancreatitis is considered idiopathic (cause is unknown) in 10 to 15% of patients.
Causes of Chronic Pancreatitis
In more than half of patients, chronic pancreatitis is caused by long-term abuse of alcohol, which leads to damage and scarring of the pancreas. Other people may develop chronic pancreatitis as a result of hereditary causes, gallstones (which block the pancreatic duct outlet), autoimmune disease such as lupus, or high triglyceride levels. The cause of chronic pancreatitis cannot be identified in about 25 -30% of patients. Evidence suggests that some cases of unidentified chronic pancreatitis may be associated with atypical mutations of cystic fibrosis genes.
In approximately 5-6% of patients with chronic pancreatitis, the disease is caused by autoimmune inflammation (in which the immune system attacks the pancreas)¹. Symptoms may be mild, but patients with autoimmune pancreatitits (AIP) tend to show elevated levels of immunoglobulin G4 (IgG4) and a high rate of pancreatic stone formation. Other indicators of autoimmune pancreatitis include narrowing of the main pancreatic duct, scarring of the pancreatic tissue, and infiltration with inflammatory cells. AIP can occur by itself or in association with other autoimmune diseases such as primary sclerosing cholangitis (PSC), primary biliary cirrhosis, retroperitoneal fibrosis, rheumatoid arthritis, sarcoidosis, and Sjögren's syndrome.
In rare cases, pancreatitis may be caused by viral infections such as mumps, coxsackie B, mycoplasma pneumonia, and campylobacter.
A more common problem in developing countries than in the U.S., intestinal parasites can lead to acute pancreatitis and other pancreatic diseases.
Dmitry L. Finkelberg, M.D., Dushyant Sahani, M.D., Vikram Deshpande, M.D., and William R. Brugge, M.D.
N Engl J Med 2006; 355:2670-2676December 21, 2006