Covid “inflates” the pancreas: “Here’s how the attack starts”


Covid can also hit the pancreas, but in most cases it appears to be due to “indirect” mechanisms. We talked about it exclusively with Prof. Massimo Falconi, Director of the Pancreas Surgery Unit, as well as Director of the Pancreas Translational & Clinical Research Center of the IRCCS San Raffaele Hospital in Milan and Full Professor of Surgery at Vita-Salute San University Raffaele.

Prof., Covid is said to also affect the pancreas. If so, how?

“There are two hypotheses of mechanism: the first is through a receptor, called Ace2, also present on pancreatic cells. Having an attack point gives the virus the potential to get inside the cells, infect them and do damage. The high hypothesis is an indirect mechanism: the pancreatitis acute is a phenomenon whereby, the enzymes secreted by pancreatic cells, instead of being activated in the duodenum where they physiologically help digestion of food, can be activated inappropriately within the pancreas itself. Thus, the activation of an enzymatic cascade takes place in an inappropriate ‘place’ and there is self-digestion of the gland, called precisely acute pacreatitis “.

How does acute pancreatitis develop?

“The most frequent causes are i calculations biliary but there is a modest percentage of acute pancreatitis also on a vascular basis. Ischemia, for example, can also lead to an acute pacreatitis. It is a rare but existing causal factor. So, since this virus has a particular tropism for the small vessels and creates a sort of inflammation of the vessels, therefore an endothelitis can affect the pancreas indirectly creating an ischemic condition that can trigger pancretitis “.

What is the symptomatology and how is it discovered?

“In what is called the ‘Atlanta classification’: a rise pancreatic enzymes, at least three times the upper normal limit, accompanied by a typically pancreatic pain symptomatology. However, in a sedated and intubated patient who does not feel pain, detecting the presence of pain is something very questionable. As far as we know so far, the organ may be affected but it is not the driver of the main complications related to the most serious forms related to Covid-19 infection “.

So, does a person not realize that the pancreas has been attacked directly?

“It is extremely rare. In a series of patients who had pancreatic involvement, only three of them had clinical symptoms compatible with pancreatitis. Obviously, the whole system also gastrointestinal is involved in it. Hence, in the most severe forms of infection, patients may complain of diarrhea and abdominal symptoms. The pancreas can be affected but, as mentioned before, it is not the driver of complications related to the disease “.

Are the damages Covid can cause similar to other pathologies affecting the pancreas? If so, which ones?

“When viral infection affects the pancreatic gland, the picture is that of acute pancreatitis edematous, i.e. the milder form of pancreatitis. In the articles published in the Chinese experience literature, patients who performed a CT scan of the abdomen in which pancreatic involvement was found, no necrosis was ever detected, which is the most serious form of pancreatitis. The involvement is there but it is a “swelling”, an edema of the gland that does not seem to lead to such substantial damage that it can actually be a problem “.

What is the percentage of people affected by the pancreas?

“It is not the organ most affected but in a percentage of patients around the 10-15%, when routine blood tests are performed, there is an increase in pancreatic enzymes which are amylases and lipases. This elevation in itself does not represent pancreatitis but indicates, to some extent, a involvement organ. Through a CT scan in patients with the most severe forms, a morphological change of the gland has also been found in 7% of the previous percentage, with an enlargement of the same as observed during acute pancreatitis “.

Can some drugs used to “cure” Covid-19 cause harm?

“These sufferers receive an indescribable amount of drugs, in some high doses such as cortisone, which in itself can be a cause of pancreatitis. The virus probably also affects the pancreatic and salivary glands and it can be assumed that the damage is not necessarily linked to the virus but could also be linked to the drugs used to try to treat the disease “.

Is there a category of people that affects you most?

“Pancreatic involvement is more frequent in patients who have a more severe form of Covid disease, in those in whom it is more aggressive. The worst forms have men, those who are of a certain age and patients with comorbidities. It can therefore be assumed for transitive properties that the same risk factors are also for pancreatic involvement “.

Are there instrumental tests that identify Covid’s presence?

“No, not you can spot it. There is someone who has studied this aspect by making pancreatic biopsies but it is an aspect related to research, not to routine diagnostics. We can see the possible damage in the context of the infection, in the rare cases in which the pancreas is affected “.

Is there a specific therapy to treat the damage caused by the virus?

“The intensive care that is used to ‘cure’ the patients suffering from the most serious forms of infection is aimed at solving the problem of Multiple Organ Failure (M or F), typical of the most serious forms of the disease. Intensive care provides support to the organs pending the organism is right about the virus “.

Is there a specific therapy to prevent it?

“Not to prevent pancreatitis which, as mentioned, is secondary virus infection. “

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