“Pancreas Clinic, Ramaiah Memorial Hospital”

The pancreas is an organ in the abdomen, situated behind the stomach. It serves important functions in the body that can broadly be divided into exocrine and endocrine roles. The exocrine role of the pancreas involves the production and secretion of enzymes that aid in the digestion of ingested food. Endocrine functions refer to the secretion of hormones, principally insulin that regulates digestive functions like blood glucose in the body.

Disorders of the pancreas are relatively common and it is important to identify these diseases early in their course in order to prevent long-term complications. Specific disorders of the pancreas include acute pancreatitis, chronic pancreatitis, pancreatic cancers, cystic lesions and autoimmune pancreatitis. These conditions can lead to characteristic symptoms and signs that merit medical attention. A few common pancreatic disorders include –

Acute Pancreatitis

Acute pancreatitis refers to inflammation of the pancreas that occurs suddenly and is frequently accompanied by significant intermittent upper abdominal pain that can be prolonged for several days. Common causes of acute pancreatitis include alcohol intake, stones in the gall bladder, certain genetic disorders and even a few drugs have been known to cause acute pancreatitis. Although most patients with acute pancreatitis recover completely, a proportion of patients require long-term follow-up in high-risk clinics for pancreas in order to look for early changes of chronic pancreatitis which will necessitate a different line of management.

Chronic Pancreatitis

Chronic pancreatitis is a disease that causes permanent damage to the pancreas resulting in progressive deterioration of pancreatic function over time. Chronic pancreatitis may present with an acute episode of pancreatitis at first and might be mistaken for acute pancreatitis because the symptoms are similar. A thorough evaluation by an expert in pancreatic disorders is essential. In the long term patients with chronic pancreatitis can have weight loss, oily stools, diabetes with poorly controlled sugars, malnutrition with vitamin deficiency and chronic abdominal pain. The most dreaded complication of chronic pancreatitis is pancreatic cancer. All patients of chronic pancreatitis require regular medical check-up with an expert in pancreatic diseases in order to screen for malignancies.

Pancreatic Cancer

Pancreatic cancer accounts for the fourth highest number of cancer-related death among males and the fifth highest number of cancer-related deaths among females. Pancreatic cancer has earned notoriety as cancer with poor response to therapy and poor outcomes. It has a propensity to spread to distant organs and is usually diagnosed later than most other forms of cancer. This is mainly due to little to no symptoms in the early stage of the disease. Once the tumor spreads to the bile duct and neighboring structures, patients can present jaundice which is, a yellowish discoloration of skin, eyes and mucous membranes. In addition, patients can present with gastrointestinal bleeding, abdominal pain, loss of weight and appetite. Diagnosis of pancreatic cancer rests mainly on blood tests and imaging modalities. The advent of Endoscopic ultrasound (EUS), has enabled pancreatic biopsy which can confirm the diagnosis. Early diagnosis of pancreatic cancer is hugely beneficial and needs more attention. Screening for pancreatic cancer in high-risk groups like chronic pancreatitis and patients with hereditary pancreatitis could be beneficial.

Pancreas clinic – A multidisciplinary approach to management of pancreatic disorders:

A specialized clinic for multidisciplinary care of patients with pancreatic disorders has been set up at Ramaiah Memorial Hospital. This clinic will offer extensive, specialized expertise in diagnosing and treating those with diseases of the pancreas.

Scope of the clinic:

The clinic offers cutting-edge diagnostic and the latest treatment options for all pancreatic disorders which include:

• Evaluation of Pancreatic masses
• Pancreatic cysts
  • Pseudocysts
  • Intraductal papillary mucinous neoplasms (IPMN)
  • Other cystic lesions of the pancreas
• Neuroendocrine tumours
• Acute pancreatitis
  • Walled-off pancreatic necrosis
  • Biliary pancreatitis
• Chronic pancreatitis and sequelae including Exocrine pancreatic insufficiency, pancreatic diabetes, etc
• High-risk pancreas cancer screening
• Autoimmune Pancreatitis
• Ampullary masses and Bile duct abnormalities

The pancreas clinic at RMH is a multidisciplinary clinic with Gastroenterologists, HPB surgeons, oncologists, endocrinologists and nutritionists who work together and establish comprehensive patient care pathways for both preventive (screening programs) as well as therapeutic indications.

In addition, the clinic will also facilitate research in the area of pancreatology in conjunction with the Central Research Laboratory of Ramaiah University of applied sciences and Centre of Molecular reproduction, development, and genetics, IISc Bangalore. This collaboration will focus on the development of novel avenues of treatment targets, diagnostic markers, and prognostic factors in patients with pancreatic disorders.

Patient education and ongoing care:

During the consultation, the team will provide a complete review of the diagnosis and treatment plan. A specialized pancreas clinical assistant will then provide high-quality patient education with specially designed handouts, and information booklets and be able to guide and answer their specific concerns. A dedicated dietician will also be involved to draft a relevant diet plan that is specialized for pancreatic disorders. Nutritional assessment will be undertaken at every visit by the dietician. Dedicated phone lines and email correspondence in encourages where patients can always have the option of reaching out to specialized care at any time of the day.   

High-Risk Pancreas Clinic

The High-Risk Pancreas Clinic is dedicated to pancreatic cancer screening in those who have a high risk of pancreatic cancer over the course of their lifetime. Such high-risk status can reflect underlying disease conditions, genetic changes associated with pancreatic cancer, or a strong family history of pancreatic cancer.

• In the High-Risk Pancreas Clinic, high-risk individuals will be offered a comprehensive assessment, including medical evaluation, laboratory testing, and imaging.
• Patients in the High-Risk Pancreas Clinic also have the opportunity to participate in research studies and clinical trials focused on the discovery and validation of novel approaches for detecting pancreatic cancer at an early and potentially curable stage.