Musician Travis Barker, most famously known as the drummer for Blink-182, was recently hospitalized with a severe case of acute pancreatitis.
"I went in for an endoscopy Monday feeling great," Barker wrote in an Instagram Story. "But after dinner, I developed excruciating pain and have been hospitalized ever since. During the endoscopy, I had a very small polyp removed right in a very sensitive area, usually handled by specialists, which unfortunately damaged a critical pancreatic drainage tube. This resulted in severe life-threatening pancreatitis. I am so very very grateful that with intensive treatment I am currently much better."
Barker was discharged on July 4. According to People, via a source close to Barker, he is "slowly on the mend and closely following his doctors' orders."
Pancreatitis
Acute pancreatitis is an inflammatory response to injury of the pancreas. It accounts for approximately 275,000 hospitalizations per year in the U.S. The majority of patients (approximately 80%) have mild disease and can be discharged within a few days. The overall mortality rate from acute pancreatitis is estimated to be about 2%.
Chronic pancreatitis, which has an annual incidence of 5 to 12 per 100,000 people, can result in permanent damage to the pancreas's exocrine and endocrine functions. It most often develops between the ages of 30 and 40 years, and occurs more commonly in men and African Americans.
Etiology
The most common causes of acute pancreatitis in the U.S. are gallstones and alcohol use. Less common causes include autoimmune pancreatitis, hypertriglyceridemia, post-endoscopic retrograde cholangiopancreatography (ERCP), genetic risk, pancreatic duct injury, and use of certain medications, including azathioprine, 6-mercaptopurine, didanosine, valproic acid (Depakene), angiotensin-converting enzyme inhibitors, and mesalamine.
The pathogenesis of acute pancreatitis is believed to be the result of pancreatic duct and acinar injury. Improper secretion of pancreatic digestive enzymes leads to auto-digestion and inflammation. Gallstones can cause temporary obstruction of the pancreatic duct, leading to leakage of digestive enzymes. Alcohol use can cause direct toxicity to pancreatic cells, as well as stimulation of an immune response.
In chronic pancreatitis, repetitive acute attacks cause inflammatory infiltrates and fibrosis, which can ultimately lead to pancreatic insufficiency, as well as diabetes.
Symptoms
Abdominal pain is the primary symptom for patients with acute or chronic pancreatitis. For those with acute pancreatitis, the pain begins either slowly or suddenly in the upper abdomen and will sometimes radiate to the back. It can be mild or severe and can last for several days. Other symptoms include fever, nausea and vomiting, rapid heartbeat, and/or a swollen or tender abdomen.
Those with chronic pancreatitis may feel pain in the upper abdomen, although some will have no pain at all. The pain can radiate to the back and can become constant and severe. The abdominal pain can diminish as the patient's condition becomes more severe. Pain is often worse after eating. Other symptoms may include diarrhea, nausea, vomiting, greasy foul-smelling stools, and weight loss.
Diagnosis
Clinicians should conduct a thorough medical history and physical exam, as well as lab and imaging tests if needed.
Bloodwork consistent with pancreatitis includes elevations in amylase, lipase, glucose, and lipid levels, and elevations in white blood count.
Useful imaging tests include ultrasound (which can pick up gallstones), CT scan, and magnetic resonance cholangiopancreatography.
Treatment
Treatment for pancreatitis includes IV hydration (and oral hydration, if tolerated), pain medications, antibiotics (if an infection is present), a low-fat diet, and nutritional support.
If gallstones are present, surgery may be recommended for their removal or for removal of the entire gallbladder. Abscesses or pseudocysts may be drained if present.
For patients with acute pancreatitis and acute cholangitis, an urgent ERCP may be recommended. This procedure can treat narrowing or blockage of a bile or pancreatic duct and can also remove gallstones blocking the ducts.
Acute Pancreatitis After GI Endoscopy
In Barker's case, his pancreatitis is said to have been caused by a complication from an endoscopy. How common is this?
According to the literature, acute pancreatitis is the most common complication of ERCP, and is referred to as post-ERCP pancreatitis (PEP). The risk of PEP may be dependent on pancreatic volume (with a large volume identified as higher risk). It may also be more common in cases in which a pancreatic duct guidewire is used in difficult cannulation cases.
Emerging therapies to prevent PEP include rectal NSAIDs, indomethacin or diclofenac, aggressive IV Ringer's Lactate hydration, and sublingual nitrate.
The incidence of acute pancreatitis in patients undergoing non-ERCP endoscopy is much lower. While some case reports of patients who developed pancreatitis after colonoscopy have been presented, with some of the procedures being described as "difficult," others were considered "routine." The pathophysiology of these cases is unclear.
Michele R. Berman, MD, is a pediatrician-turned-medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children's Hospital. Her mission is both journalistic and educational: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.