The 'angry organ'

The recent explosion of interest in our gut microbiomes has prompted renewed interest in digestive diseases by both academic and pharmaceutical research communities.  However, for every unique individual there is a unique digestive system and a unique microbiome and therefore the possibility for unique disease or combination of disorders.  Despite high incidence, however, some of the most well understood yet severely under-researched and clinically ignored digestive maladies remain low priority for research funding allocation.  Several of these diseases and disorders include malfunction and mis-regulation of critical components of our digestive system - the liver, colon, intestines and (my favorite) the pancreas.

Increased hospitalizations due to acute and chronic pancreatitis alone constitute a heavy burden on the US healthcare system.  Chances are, you know at least one individual hospitalized from pancreatitis - annual admissions have risen to nearly half a million Americans. Too much to eat or drink around the holidays?  The resulting abdominal pain may be from the stomach as most people suspect, but there is a good chance it is from the pancreas (which hides just behind the stomach and is often neglected in Emergency Room settings).  Other diseases and disorders which have a pancreatic component are types I and II diabetes (T1D and T2D, respectively), cystic fibrosis and Shwachman-Diamond syndrome (the later two being extremely rare).  Both endocrine and exocrine pancreatic insufficiencies are a symptom of some form of pancreatic malfunction, and it is well established that pancreatic cancer comes with a higher mortality rate than most (although recently published research may improve detection of early stage (I and II) pancreatic cancer).

Describing and treating diseases of the pancreas proves challenging due to the highly sensitive and often extremely reactive nature of this gland.  Physicians avoid palpating or working anywhere near the 'angry organ' due to the likelyhood of induced pancreatitis. Due to the increased volume of reported pancreatic disorders and comparative inexperience in dealing with the pancreas (as opposed to the liver or stomach, for example) both in the lab and on the operating table, a promising research arena exists and is in desperate need of attention.  Pancreatitis (inflammation of the pancreas), which is a component of most pancreatic diseases and disorders, may be broadly classified into three categories - acute (short lived, often related to an isolated incident), chronic (persistent, often related to alcohol consumption or gall stones) and idiopathic (a fancy term for 'unknown cause').  The mechanisms of action through which acute and chronic pancreatitis occur are more thoroughly documented (click here for a recent review about acute pancreatitis), but an increasing number of individuals present with idiopathic pancreatitis.  Much like a diagnosis of fibromyalgia, the diagnosis of idiopathic pancreatitis is often one of elimination when no other obvious cause for symptoms is discovered.  The root cause of discomfort and additional symptoms may remain elusive for years or never fully resolve.  

An understanding of the many personalities of the pancreas, and how each persona interacts with the rest of our digestive system, may explain points of malfunction and misdiagnosis - and hopefully provide relief for those of us still asking 'what is going on and why is this happening?'