COVID-19 and the risk of acute pancreatitis: Here’s what an expert advises

"Upper abdominal pain among COVID-19 patients should be always evaluated from pancreatitis point of view," says Dr Swapnil Sharma, of Fortis Hospital, Mulund

The novel coronavirus that causes COVID-19 can cause other health complications, too. While it was declared a pandemic by the World Health Organization on March 11, 2020, across the globe, countries are still scrambling for answers as to how it can be contained and eventually eradicated. As it is known, the viral infection mainly attacks the upper respiratory tract system. But, apart from that, it is also known to impact the digestive system, causing nausea, vomiting and diarrhoea.

It has come to the fore, that the virus can also attack the pancreas. “Incidence of pancreas involvement in COVID-19 patients with pneumonia is around 17 per cent, but the degree of pancreatic involvement varies from patient to patient. Some patients can have an isolated rise in the pancreatic enzymes in their blood test without any clinical symptoms. There may be raised pancreatic enzymes on blood tests and signs of pancreatitis on imaging, but there will not be any clinical disease. Very rarely, there may be an overt episode of acute pancreatitis; usually, the pancreatic involvement chances are less when COVID-19 disease is mild,” explains Dr Swapnil Sharma, consultant, liver transplant & HPB surgery at the Fortis Hospital in Mulund.

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Dr Sharma says COVID-19 can cause pancreatic injury either by direct viral invasion, or indirectly via immune-mediated injury. “Pancreatic cells express a particular type of receptors which are called ‘Angiotensin-Converting Enzyme 2 (ACE2)’, which help the COVID-19 virus to move inside cells. The isolated pancreatic enzymes elevation on blood test should not be labelled as acute pancreatitis among COVID-19 patients. Acute pancreatitis should be diagnosed in COVID-19 patients with raised pancreatic enzymes on blood test only when there is a clinical disease and/or imaging showing typical signs of acute pancreatitis.”

But, what is the treatment?

– Patients with acute pancreatitis need supportive care like intravenous fluid, painkillers and nutrition.
– Early aggressive intravenous fluid resuscitation and nutritional support is key to prevent serious complications of acute pancreatitis, such as pancreatic necrosis.
– If COVID-19 patients develop severe acute pancreatitis, there is high risk of multi-organ failure and mortality.

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The virus can cause multisystem involvement, and although COVID-19 induced acute pancreatitis is rare, it can cause severe damage to the patient as the target organ of both COVID-19 and pancreatitis is the same, the doctor warns.

“Both of them can cause severe inflammatory responses. Upper abdominal pain among COVID-19 patients should be always evaluated from pancreatitis point of view. Acute pancreatitis among COVID-19 patients, if not identified timely and managed properly, can be lethal,” he says in conclusion.

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