Review on chronic pancreatitis and homoeopathic management

Dr Deepthi B¹ Dr Shweta B Nanjannavar²  

ABSTRACT
Chronic pancreatitis is a pancreatic inflammation of multifactorial, fibroinflammatory syndrome in which repetitive episodes of pancreatic inflammation and fibrosis the end point of which is destruction of pancreatic parenchyma with eventual loss of exocrine and endocrine function. Using the standard diagnostic criteria, clinical features, pathology, mechanism of pain and imaging criteria are very helpful in diagnosing the chronic pancreatitis. Homoeopathic management and few case reports are shown the efficacy of Homoeopathic medicines in chronic pancreatitis.

Keywords: Chronic pancreatitis, Homeopathy, Endoscopic retrograde cholangio-pancreatography (ERCP)

PANCREATITIS

• Pancreatitis, inflammation of the pancreas, occurs in acute and chronic forms and may be due to edema, necrosis, or hemorrhage. In men this disease is commonly associated with alcoholism, trauma, or peptic ulcer; in women, it’s linked to biliary tract disease. The prognosis is good when pancreatitis follows biliary tract disease, but poor when it follows alcoholism.

CHRONIC PANCREATITIS (CP) is characterized by pancreatic inflammation and fibrosis the endpoint f which is destruction of pancreatic parenchyma with eventual loss of exocrine and endocrine function.

• The pancreas is an accessory organ of digestion known to have dual functions in the endocrine and exocrine systems. It is necessary for the hydrolysis of macromolecules including proteins, carbohydrates, and fats (in combination with bile from the common bile duct).
• The pancreas has a main pancreatic duct running through the length of it, an accessory duct, and many various cell types. The ducts can become blocked, or they can be genetically deformed.
• During constant inflammation, scarring and fibrosis of the ducts lead to permanent damage to many structures, impairing its secretory functions.
• The disease is prevalent in India although there are variations in the pattern and causes of the disease in different parts of the country.

AETIOLOGIC RISK FACTORS ASSOCIATED WITH CHRONIC PANCREATITIS:

TIGAR-O Classification System

TOXIC-METABOLIC–

• Alcohol,
• tobacco smoking,
• hypercalcaemia (hyperparathyroidism),
• chronic renal failure,
• medications (phenacetin),
• toxins (organotin compounds, e.g. DBTC)

IDIOPATHIC

• Early onset (or) late onset
• Tropical (tropical calcific pancreatitis, fibro-calculous pancreatic diabetes)

GENETIC

• Autosomal dominant (Cationic trypsinogen codon 29 and 122 mutations)
• Autosomal recessive/modifier genes (CFTR mutations, SPINK1 mutations Cationic trypsinogen codon 16, 22, 23 mutations, α1-antitrypsin deficiency)

AUTOIMMUNE

• Isolated autoimmune chronic pancreatitis
• Syndromic autoimmune chronic pancreatitis (Sjögren syndrome

associated chronic pancreatitis, inflammatory bowel disease-

associated chronic pancreatitis, systemic lupus erythematosus (SLE) Primary biliary

cirrhosis—associated chronic pancreatitis)

RECURRENT AND SEVERE ACUTE PANCREATITIS

• Post-necrotic (severe acute pancreatitis),
• recurrent acute pancreatitis,
• vascular diseases/ischaemic,
• post-irradiation

OBSTRUCTIVE

• Pancreatic divisum,
• sphincter of Oddi disorders,
• duct obstruction (e.g. tumour)
• Pre-ampullary duodenal wall cysts,
• post-traumatic pancreatic duct scars
• New studies are finding that deficiencies in certain vitamins and antioxidants may be linked to the disease.
• The most common cause is alcohol consumption.
• The alcohol increase secretion of proteins from acinar cells, causing the fluid to become viscous, leading to ductal obstruction, acinar fibrosis, and atrophy. Fortunately, less than 10% of alcoholics develop In chronic pancreatitis, suggesting that other mechanisms play a role in the pathology.

Other common causes include:

• Hyperlipidemia (usually types 1 and V)
• Nutrition
• Obstruction of the duct (either congenital or acquired)
• Medications

CLINICAL FEATURES:

7. Pain relives on Sitting (or) leaning forward Knee – chest position on one-side  (or) squatting and clapping the knee to the chest.

8. Pain may increase after a meal and is often nocturnal

9. Causes for pain – pancreatic inflammation, increased intra pancreatic pressure and alterations in nerves.

10. Fat malabsorption leads to steatorrhea and weight loss is common.

11. Some pts complain of bulky, foul-smelling stools.

12. Vit B12 deficiency (exocrine failure), Diabetes mellitus (endocrine failure)

13. In late stages, mechanical obstruction of common bile duct can occur.

HOMOEOPATHIC THERAPEUTICS FOR CHRONIC PANCREATITIS:

1. PHOSPHORUS:

• Tuberculosis and fatty degeneration in different organs specially heart, pancreas, liver and kidney.
• Distressing, burning pains in coeliac axis.
• A very weak, empty or gone sensation, felt in whole abdominal cavity, sharp pains through abdomen, shootings in hepatic region, distention of abdomen especially after a meal.
• Stools undigested, containing particles of fat or looking like cooked sago.
• Pale yellow face, anaemia, atrophy of pancreas with diabetes mellitus.
• Neuralgia of coeliac plexus.

2. IODUM:

• Great emaciation, hungry, anxious.
• Eat anoromously but yet grows thin.
• Pancreas enlarged, whitish, whey like diarrhoea, abdominal pulsations, soapy taste, fat in stools, tabes mesentrica
• Glands enlarged or atrophied.
• Throbbing pain at pit of stomach.
• Empty eructations as if every particle of food were turned into gas.
• Abdominal pains which return after every meal, inflation of abdomen, enlargement of abdomen which renders it impossible to lie down without danger of suffocation.

3. IRIS VERSICOLOR:

• Burning distress deep in pancreatic region not > by cold water, vomiting of sweetish wate, saliva greesy taste.
• Green watery diarrhoea < 2-3am.
• Offensive flatus, smelling like copper, stools contain undigested food or fat.
• Bilious vomiting.
• Colic > bending forward, discharge of flatulency.
• Cutting pain in lower part of abdomen, foetid flatulence, sharp gripping pains in the bowels.

4. BELLADONNA:

• Catarrh of salivary ducts, peculiar odour from mouth but slightly with coated tongue.
• Thick white mucus collects in mouth and throat with constant inclination to hawk and swallow.
• Constriction of abdomen around navel as if a ball or lump would form.
• Shootings in left side of abdomen on coughing, on sneezing and on being touched.
• Pressure in abdomen as if by a stone, chiefly in lower part of abdomen and in the groin.
• Painful pressure in pit of stomach especially after eating.

5. KALI – IOD:

• Rancid taste in mouth after eating or drinking.
• Viscid, saltish saliva, gulping of large quantities of air.
• Burning in pit of stomach.
• Cutting and burning around navel, emaciation and loss of appetite.
• Painful distention beneath umbilicus > stool.
  Sticking at left side of abdomen.
• Constriction in left side on a line with cardiac orifice of stomach.

6. ARSENICUM ALBUM:

• Organic degenerations with great restlessness and despair, ulceration of duodenum which by extension involves the pancreatic duct perhaps the results of burns of malignant disease etc.
• Neuralgia of coeliac plexus, stools undigested containing fat.
• Swelling of the spleen, excessive pains in the abdomen, principally on the left side and often with great anguish in the abdomen.
• Inflation of the abdomen, ascites, hard bloated abdomen, violent cutting, cramping like pains, digging, pulling, tearing and gnawing in the abdomen.
• Attacks of colic occur chiefly after having drunk or eaten or in the night often accompanied by vomiting or diarrhoea with internal heat or cold sweat.

7. PULSATILLA

• Inflammation of abdomen with great sensitiveness to pressure.
• Drawing tension in hypochondria or pulsative shootings as in an abscess.
• Pressure in abdomen and small of back as from a stone.
• Colics are often associated with vomiting or diarrhoea.
• They manifest themselves mostly in the evening or after eating or drinking ameliorated by squeezing the abdomen.

8. SPONGIA TOSTA

• Abdomen hard and tight, spasms in abdomen, violent action of abdominal bowels during inspiration.
• Viscera drawn up against diaphragm.
• Pain in left side of abdomen, digging and choking > after discharge of wind at times as if something alive were moving there.
• Gripping in abdomen after a meal.
• Rumbling in the abdomen especially in evening and morning when lying down.

FEW HOMOEOPATHIC CASE REPORTS REVIEW

From the International journal of Ayush case reports

• A rare case of chronic recurrent pancreatitis with pseudo cyst which was treated by the author H. Venkatesan (Research scholar & Associate prof) from Vinayaka Mission’s Homoeopathic Medical College and Hospital (Salem, Tamil Nadu)
• A male patient of 36 years age He was suffering from Chronic Pancreatitis with Pseudo cyst of size 6.2cms x 5.1cms and suggested for surgery. The usual treatment protocol is surgical resection and drainage of pseudo cysts. He was already treated by Necrosectomy twice and aspirated for the same

Homoeopathic Medicines Spongia toasta and Irsis versicolar for about 2 years with no recurrence and good quality of life.

prescribed Iris Versicolor-Q [5-7] 10 drops three times a day as an initial prescription. Later after complete case taking individualized remedy is selected as Spongia toasta 30c – 10M.

From Journal of Integrated Standardized Homoeopathy

• chronic relapsing pancreatitis in a pediatric patient by the author Bipin sohanraj Jain et.al from the (Department of Homoeopathic Materia Medica, Dr M. L. Dhawale Memorial Homoeopathic Institute, Palghar, Maharashtra)
• A 9-year-old girl who presented with the complaint of a long recurrent fever, abdominal pain & vomiting’s.
• On initial prescription, As an acute totality according to Boger’s approach the Pulsatilla 30c was given, later the complete case was taken for constitutional remedy as her constitution was matching with same remedy they continued in a repeated doses with increased potency 200.

References

1. Post graduate medicine by B.B. Thakur
2. API Textbook of medicine
3. Oxford textbook of medicine
4. Homoeopathic Treatment protocol in the management of Chronic Recurrent Pancreatitis with Pseudo Cyst- A Rare Case Report https://www.ijacare.in/index.php/ijacare/article/view/50
5. Homoeopathic management of chronic replapsing pancreatitis in a paediatric patient: A case report https://jish-mldtrust.com/homoeopathic-management-of-chronic-replapsing-pancreatitis-in-a-paediatric-patient-a-case-report/
6. Treatment of Chronic Pancreatitis https://www.wellinghomeopathy.com/treatment-of-chronic-pancreatitis/
7. Chronic Pancreatitis https://www.ncbi.nlm.nih.gov/books/NBK482325/
8. Chronic pancreatitis diagnostic criteria https://www.wikidoc.org/index.php/Chronic_pancreatitis_diagnostic_criteria
9. A Dictionary of Practical Materia Medica – J H Clarke

Dr Deepthi B¹ Dr Shweta B Nanjannavar^2
1 PG Scholar, Department of practice of medicine, A.M. Shaikh Homoeopathic Medical college, Belagavi
² Professor, PG Guide, Department of practice of medicine, A.M. Shaikh Homoeopathic Medical college, Belagavi