Acute pancreatitis: An interview with Viktor Oskarsson

Could you tell us a little bit about acute pancreatitis? What is it and who does it affect?

Acute pancreatitis is an inflammatory disease of the pancreas. The most common symptom is acute abdominal pain, which is often accompanied with nausea and vomiting.

Most patients have a mild course and are fully recovered after a few days. Up to 20% of the patients, however, have a severe course with a potentially lethal outcome.

Both men and women may develop acute pancreatitis, but the disease is more common among men. The average age at diagnosis is around 60 years.

What causes acute pancreatitis?

The major causes are thought to be gallstones and alcohol abuse. In addition, several less common causes have been proposed; for example certain medications, infections and surgical complications.

A large portion of patients, however, are classified as idiopathic acute pancreatitis—that is, without any cause for the disease being found.

Your recent research suggests that acute pancreatitis may be staved off by a diet rich in vegetables. Can you explain to us how you think this prevention works?

We found an inverse association between vegetable consumption and risk of acute pancreatitis. This association was similar for men and women.

Being an observational study (where we have classified participants according to vegetable consumption and thereafter followed them for development of acute pancreatitis), the exact molecular mechanisms are unclear.

The most likely mechanism can, however, be ascribed to the antioxidant content of vegetables.

Previous research has indicated that free radicals (by-products of cellular activity) and oxidative stress (a state with excessive amounts of free radicals) is associated with deleterious effects in the development of acute pancreatitis.

It is, therefore, possible that a high consumption of vegetables and subsequent intake of dietary antioxidants—molecules that counters the effect of free radicals—may be protective against acute pancreatitis.

How did the research originate, i.e. how did you decide to look at vegetable consumption in relation to acute pancreatitis?

We know that oxidative stress is reported to play an important role in the development of acute pancreatitis.

Therefore, we hypothesized that consumption of vegetables and fruit might protect against the disease owing to their rich content of antioxidants.

Furthermore, the role of vegetables and fruit in relation to acute pancreatitis has been sparsely examined.

The research showed that fruit consumption did not affect risk of acute pancreatitis, whereas vegetable consumption did. Could you explain why you think this is the case?

The lack of association between fruit consumption and risk of the disease was somewhat unexpected.

Fruits are also rich in antioxidants but—as compared to vegetables—contain higher levels of fructose (fruit sugar).

Experimental studies have previously indicated that fructose may be associated with production of free radicals, which might counter the effect of antioxidants.

Future research is, however, needed to fully understand the role of both vegetables and fruit in relation to development of acute pancreatitis.

The recent press release refers to a diet “rich” in vegetables; how many vegetables per day are required to have the protective effect?

Participants in the highest category of vegetable consumption had around 4 or more servings per day, whereas those in the lowest category (the reference group) had around 1 or fewer servings per day.

The general recommendation regarding consumption of vegetables and fruit is 5 servings per day.

Encouragement of increased vegetable consumption may be beneficial for the prevention of acute pancreatitis.

The research you carried out was on acute pancreatitis that is unrelated to gallstones. Please could you explain the reason for only focussing on this and not including acute pancreatitis that is related to gallstones?

There are two main reasons. Firstly, the large portion of patients with acute pancreatitis that is classified as idiopathic pancreatitis.

Secondly, the fact that only a minority of chronic alcohol abusers develops acute pancreatitis.

We, therefore, wanted to examine if non-gallstone-related acute pancreatitis may be associated with other factors—that is, consumption of vegetables and fruit.

Gallstones also induce acute pancreatitis by mechanical obstruction of the bile duct and/or the pancreatic duct (the ducts connecting the gallbladder and the pancreas with the intestine, respectively).

This mechanical obstruction is not the case for other proposed causes of acute pancreatitis.

What do you think the future holds for research into acute pancreatitis?

Further research on potential factors that may affect both first-time and recurrent attacks of acute pancreatitis.

An improved knowledge of these factors is important in the prevention of the disease.

Research on management and treatment of patients who develop acute pancreatitis is equally important.

Where can people go to find more information on the research?

The study was recently published at the homepage of Gut:

[Vegetables, fruit and the risk of non-gallstone related acute pancreatitis: a population based prospective cohort study Online First doi 10.1136/gutjnl-2012-302521]

http://gut.bmj.com/content/early/2012/06/08/gutjnl-2012-302521

About Viktor Oskarsson

Viktor Oskarsson completed his medical degree at Karolinska Institutet, Sweden. He is currently a PhD-student at the Institute of Environmental Medicine, Karolinska Institutet. Viktor Oskarsson´s research interest is focusing on acute pancreatitis.

April Cashin-Garbutt

Written by

April Cashin-Garbutt

April graduated with a first-class honours degree in Natural Sciences from Pembroke College, University of Cambridge. During her time as Editor-in-Chief, News-Medical (2012-2017), she kickstarted the content production process and helped to grow the website readership to over 60 million visitors per year. Through interviewing global thought leaders in medicine and life sciences, including Nobel laureates, April developed a passion for neuroscience and now works at the Sainsbury Wellcome Centre for Neural Circuits and Behaviour, located within UCL.

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