Causes and Risk Factors for Pancreatitis
If digestive enzymes in pancreatic juice become active before leaving the pancreas, they can begin to "digest" the organ itself (called autodigestion), causing pancreatitis. The exact mechanism that causes the enzymes to become active within the pancreas is not well understood; however, the process may be related to a malfunction or blockage in the biliary system (e.g., liver, gallbladder, bile duct) or the pancreatic duct.
The most common causes for pancreatitis are alcohol abuse and gallbladder disease (e.g., gallstones).
Pancreatitis also can be genetic (called hereditary pancreatitis) or can develop as a result of abdominal trauma (e.g., injury, surgery). Patients who smoke cigarettes are at increased risk, especially if they also abuse alcohol. In about 30% of cases, the cause for pancreatitis is unknown (idiopathic).
In children, inherited conditions (e.g., cystic fibrosis), congenital (i.e., present at birth) abnormalities (e.g., pancreas divisum), and illnesses (e.g., Kawasaki disease, Reye's syndrome) can increase the risk for pancreatitis. Kawasaki disease, also called Kawasaki syndrome, is more common in children who are younger than 5 years of age. It often affects the skin, the mouth and throat, and the lymph nodes, and causes a high fever (above 104° F) for several days. If not properly treated, Kawasaki disease can damage blood vessels and organs, including the pancreas and the heart.
Reye's syndrome, also called Reye syndrome, is a serious illness that is associated with aspirin use in children younger than age 18. Reye's syndrome can affect all organs of the body, including the pancreas, and may be fatal.
Other pancreatitis risk factors in children and adults include the following:
- Bacterial infections (e.g., Mycoplasma, Campylobacter)
- Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP)
- Metabolic disorders (e.g., hyperparathyroidism)
- Obstructions in the biliary system
- Peptic ulcer (occurs in the lower end of the esophagus, the stomach, or the duodenum)
- Systemic lupus erythematosus
- Viral infections (e.g., mumps, coxsackievirus)
Certain medications also can increase the risk for pancreatitis. These drugs include the following:
- Azathioprine, 6-mercaptopurine (immunosuppressive drug used to treat rheumatoid arthritis and following organ transplant; e.g., Imuran®)
- Diuretics (used to reduce edema [swelling] in patients who have chronic heart failure [CHF], liver disease, and kidney disease; e.g., furosemide [Lasix])
- Didanosine or ddI (used to treat HIV infection; e.g., Videx)
- Estrogens (oral contraceptives; used to prevent pregnancy)
- Pentamidine (used to treat some types of pneumonia; e.g., Nubupent)
- Tetracycline (antibiotic used to treat bacterial infections; e.g., Sumycin)
- Valproic acid (anticonvulsant used to treat complex partial seizures; e.g., Depakene)