I have repeated bouts of pancreatitis. I would like to understand why I’m one of the few persons with cystic fibrosis who experiences this type of complication. How does pancreatitis develop and how can I reduce the number of episodes? Finally, I would like to know whether it is possible to solve this problem once and for all.

It is true that most people with cystic fibrosis do not suffer from acute pancreatitis. Right from birth, the secretions in most of these individuals are so viscous that they obstruct the pancreatic ducts. This leads to deterioration of the pancreas through the development of scar tissue and cysts (thus the name: cystic fibrosis of the pancreas). The production of pancreatic enzymes is seriously compromised, so these people, who are described as pancreatic insufficient, have to take enzymes in capsule form to absorb nutrients.

A minority of people with cystic fibrosis, however, can be carriers of a so-called minor mutation on one of the chromosomes. Usually, these mutations are associated with a much lesser degree of digestive system problems. The pancreatic secretions are less viscous, there is sufficient pancreatic enzyme production and the pancreatic tissue is relatively intact. These cystic fibrosis patients are described as pancreatic sufficient: they do not suffer from malabsorption and thus do not have to take enzymes with every meal. Their pancreatic secretions are nevertheless more viscous than those of normal people and can cause an obstruction leading to an accumulation of enzymes in the healthy pancreatic tissue. This, in turn, leads to pancreatic self-digestion causing severe inflammation and pain, which is the essence of acute pancreatitis. Obstruction can also result from biliary calculi (gallstones), which usually develop in the gallbladder (gallstones occur more frequently in persons with cystic fibrosis than in the general population). The gallstones can block the main pancreatic duct and cause acute pancreatitis.

Pancreatitis can also be triggered by toxicity resulting from alcohol, drug consumption or an excessive amount of triglycerides or calcium in the blood. Many forms of pancreatitis can be prevented, except those related to excessively viscous pancreatic secretions.

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