Pankreas Klinik Schweiz

Conservative therapy measures
for pancreatic diseases

The treatment of pancreatic disorders requires precise analysis. Conservative therapies can only be used, if the nature of the disorder is known, if pancreas cancer can be excluded or the tumour is inoperable. These therapies are an important post- operative tool.

The right nutrition

Nutrition plays a crucial role. Sufferers of pancreatic disorders should eat at least 6 times a day. This applies regardless of the exact nature of the pancreatic disorder except for acute phases of the disease or immediately after surgery, where special measures would be taken.

It is important that enough calories be fed to the body. Often, the weight loss we associate with the disease can be explained by the patient's insufficient food intake. Intake of fats is usually the problem, as they normally represent the main calorie providers and pancreas sufferers cannot easily absorb nutritional fats. An easily digestible fat is required and intake must be increased on a very gentle gradient. Middle-chained triglyerides (MCT-fats) such as margarine or oil can be consumed as additional energy source. These substances are beneficial, as they do not need to be broken down by digestive enzymes. Every pancreas sufferer should consult a nutritionist.

Exocrine loss of function of the pancreas

Repeated acute phases of the disease can reduce healthy pancreatic tissue to such an extent that digestive enzymes can no longer be produced in sufficient quantity to digest food. Undigested food particles remain in the intestines and cause bloating and diarrhoea, which will inhibit resorption (assimilation through intestines).

This deficiency can be addressed with insulin replacement, using a processed and cleaned enzyme substitute produced from animal organs. However, some important factors must be considered: Enzymes must be taken with meals to be merged with the food. The quantity of stomach acid produced needs to be limited with acid inhibiting medication if the patient's stomach is fully intact. Normally, stomach acid is neutralised by the bicarbonate produced in the pancreas, but if the pancreas is not able to neutralise acid, food will remain sour in the intestines. Enzymes are not very effective under such conditions, even when taken as capsules. Some drugs are better than others. Declared enzyme quantities may be released too early or too late so that they will not be effective when needed in the intestines. If diarrhoea persists, the type of medication should be changed. A generous dosage should be taken, and only once food resorption is satisfactory, can the dosage be wound back.

As fat resorption is not always reliable, the metabolising of fat-soluble vitamins can be disrupted (these, by definition, need fat to be absorbed by the body). A blood test can ascertain the level of these vitamins (A, D, E, K) in the blood and an injection into muscle tissue will correct deficiencies found in the test. The intake of vitamins in tablet form is only advisable if the patient's resorption is effective. With these measures, deficiencies can be addressed before potential new disorders take hold. Bone damage such as osteoporosis and osteomalacia as well as vision impairment and skin damage are potential consequences, if vitamin deficiencies remain untreated.

Endocrine loss of function of the pancreas

Surgery and inflammation can reduce the number of insulin producing cells to such a degree that diabetes mellitus will develop. In many cases this disease also heralds the early development of pancreatic cancer. Diabetes patients suffer from a genuine insulin deficiency and treating the condition with tablet medication will only be successful in the short-term, if at all. It is important that diabetes sufferers have several smaller meals.

The deficiency in insulin producing cells during post-surgical treatment is of great significance, as the production of the insulin counterpart glucagon will also be non- existent, due to the lack of the same cell tissue. If patients inject themselves with insulin and, for whatever reason, miss out on food, they run the risk of acute blood sugar deficiency (the protective reaction of the body, which normally injects glucagon into the bloodstream when this occurs, is disabled due to the lack of pancreatic tissue). Blood sugar levels of patients without pancreas will therefore be kept somewhat higher, especially if no diabetes-induced long-term damage can be observed.

Post-operative check-ups and patient self help

Patients who have undergone pancreas surgery or those who suffer from chronic pancreatitis should be monitored on a regular basis to detect possible changes in their condition early on. This would include patients with diabetes, metabolism disorders such as deficiencies due to a lack of metabolised nutrients and vitamins and patients with any other personal complaint. The individual patient's medical history and condition will determine how frequently and to what extent these assessments should be carried out.

A self-help group has been established in Switzerland to help patients deal with post- operative stress.

Look for similar organisations in your area where patients are helping each other out to overcome post-operative stress and share their experiences for mutual benefit.