May 18, 2023

Early intervention vital to prevent severe acute pancreatitis

SAP
Only 20% of patients with acute pancreatitis developed severe disease but the risk of death is high for older people. [Source: Shutterstock]

Key points

  • About 52% of people with severe acute pancreatitis are above the age of 55
  • Only 2 in 3 people (67%) will survive within one year after a diagnosis of severe acute pancreatitis that requires ICU, according to research from the Dutch Pancreatitis Study Group
  • As there is no specific cure for severe acute pancreatitis

A new study has called for quicker diagnosis and treatment of severe acute pancreatitis (SAP) for older people as mortality rates among the demographic rank higher than all others. 

Medical experts in Australasia have been raising concerns about the rising burden of SAP in hospitals and Intensive Care Units (ICU) for years and mortality rates have stayed the same for almost two decades.  

While the focus of the Flinders University and Australian and New Zealand Intensive Care Society (ANZICS) collaborative study was mainly on SAP in the ICU, only 20% of patients with acute pancreatitis developed severe disease but the risk of death was high for older people. 

With this in mind, academics have called for more targeted clinical research to find treatments to reduce prolonged hospital stays and mortality rates among older people.  

What is SAP?

The pancreas has two important jobs:

  • To produce enzymes that digest our food 
  • To produce insulin which helps combat diabetes

The pancreas is situated in front of our backbone and when SAP occurs, those enzymes leak into the body tissue and begin digesting it. The body’s response is to draw fluid from inside the blood vessels into those tissues to dilute the toxic enzymes which in turn causes dehydration.

The two most common causes of SAP in Australia are gallstone disease and alcohol consumption which can present in patients during the onset of upper abdominal pain paired with nausea.

Why does SAP occur more in older people?

Lead author of the Flinders University study, Associate Professor S. George Barreto, a Flinders Medical Centre surgeon, explained that the study found older people were associated with higher mortality rates in hospitals and ICUs.

“The study still points to the fact that there’s a lot of work that needs to be done to identify patients who are going to develop acute pancreatitis so that we can start to direct them to specific, supportive measures early on,” he said.

Savio Barreto
Flinders University Associate Professor S. George Barreto. [Source: Supplied]

Professor Barreto also noted that while there is no cure for SAP, standard treatment requires intravenous fluids to be pumped into the body to curb dehydration caused by the condition but older people who present to the hospital often have other comorbidities that can prevent them from accessing treatment. 

“Older patients tend to have cardiac diseases and renal problems which restrict our ability to give them the amount of fluid they need to combat dehydration,” he said. “They also often have diabetes and other comorbidities which start to feed into the catabolic state that pancreatitis is in.”

What can be done? 

As general advice, watching what you eat and how much alcohol you consume is one way to reduce your risk of getting SAP. 

But clinically, there are some things General Practitioners (GPs) and aged care workers can do to help diagnose SAP early on and implement treatment before it progresses. 

Professor Barreto recommends that concerned GPs should add two vital enzyme markers when doing blood tests on patients that detect SAP. 

Serum amylase or serum lipase are the two enzyme markers and if they are very high, that might be the first indication that a patient has SAP and then access treatment sooner rather than later.

Aged care workers can also play a role in advocating for their older clients by flagging off a client who is experiencing sudden upper abdominal pain to a qualified clinician.

“It may be many different things but it’s important to at least consider it because if you don’t, that can delay treatment and could potentially affect the outcome of that patient.”

Have you or someone you care for experienced SAP? Let us know in the comments below. 

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