Chronic Pancreatitis and COVID-19

26th February 2021

The COVID-19 pandemic has changed life for everyone with major changes to the way we currently live our lives. The promise of hope is on the horizon with better understanding of the virus and the roll out of the vaccine. For people with underlying health conditions, COVID-19 has caused further anxiety. For some groups, there has been guidance on who is at risk. For people with pancreatitis, there has been no specific guidance and therefore calculating the risks associated with COVID-19 is difficult.

Overall, pancreatitis is not listed as one of the conditions noted as leading to a status of clinically extremely vulnerable (CEV) in the UK however it is not as simple as this and individual circumstances need to be assessed.

Acute pancreatitis

Most patients with acute pancreatitis don’t know they are going to develop this condition, which makes it impossible to assess prior to the illness. A recent study led from Newcastle has shown that infection with COVID-19 increases the severity of pancreatitis and is associated with worse clinical outcomes.1 The best course of action is by prevention using social distancing, regular handwashing and vaccination when offered.2

Recurrent acute & chronic pancreatitis 

As above, these conditions are not currently recognised as leading to a clinically extremely vulnerable status. However, some subgroups may be at greater individual risk and should have their risk assessed by consulting with their GP and pancreas specialist. For those of working age, a risk assessment should also be performed by their employers. This process will identify risks associated with the workplace, in combination with the individual risk and should seek to reduce that risk to as low as is possible. The employer’s occupational health team may be involved in supporting the employer to estimate these risks. The Health and Safety Executive has information for employers on how to conduct appropriate risk assessments: Risk assessment – Working safely during the coronavirus (COVID-19) pandemic (hse.gov.uk)

Frequently Asked Questions:

Does COVID-19 cause pancreatitis?

There is evidence that the virus can bind to pancreas cells and grow there.3 There are some reports of patients developing acute pancreatitis after contracting COVID-19 but no actual proof that the virus was the cause.4 However, in a patient with acute pancreatitis, co-infection with COVID-19 leads to worse outcomes.1

Does the vaccine cause a flare up of pancreatitis?

There are no current published reports of any of the vaccines causing a flare up of pancreatitis. As COVID-19 leads to worse outcomes with acute flares, reducing that risk by having the vaccine would be advisable when offered.

I have chronic pancreatitis, should I get the vaccine?

Chronic pancreatitis may be associated with increased risk of complications from COVID-19 infection.  To reduce this risk it would be recommended to receive vaccination when offered.

I have chronic pancreatitis that possibly is autoimmune related – is it safe to have the vaccine?

People with autoimmune disease are often on medications that suppress the immune system which would make them at higher risk from COVID-19 and some would be considered as clinically extremely vulnerable. You should be vaccinated as per your risk group.

I have chronic pancreatitis and have not yet been put on the list for the vaccine, what should I do?

You should continue current guidance concerning social distancing and hygiene measures and receive the vaccine when offered.

I have chronic pancreatitis due to a genetic condition, am I at higher risk and should I get the vaccine?

You may be at higher risk of complications of COVID-19 infection.  You should be encouraged to receive the vaccine when offered.

I have pancreatitis, should I be allowed to work?

You should follow the current government guidelines for working e.g. if possible work from home. If you cannot work from home then your employer should carry out a risk assessment. See link to Health and Safety executive.

Below are some factors (not an exhaustive list) to take into consideration when assessing risk in people with pancreatitis:

  1. The biggest risk factor for COVID-19 is age, particularly over 70 years.
  2. Patients with diabetes of any cause are at higher risk, individuals with pancreatic diseases may have associated diabetes.
  3. Those on immunosuppression for any reason. Pancreas specific reasons includes IgG4 disease/autoimmune pancreatitis. Some immunosuppressive agents are more important than others such as methotrexate and rituximab.
  4. Those with pancreatic disease due to cystic fibrosis need to follow the national guidance given by the Cystic Fibrosis Foundation.
  5. Some might have other reasons to be considered as clinically extremely vulnerable e.g. stage 4 CKD or complications of diabetes.
  6. In some circumstances it is the combination of multiple factors that lead to greater risk and ultimately being considered as clinically extremely vulnerable, for example, underlying heart disease, lung disease, liver disease, BMI>35, chronic kidney disease, smoking or cancer treatments.

By Dr John Leeds, Consultant Pancreaticobiliary Physician, Freeman Hospital, Newcastle Upon Tyne, UK. Dr Clare Leeds, Consultant Occupational Health Physician, County Durham and Darlington NHS Foundation Trust, UK.

References:

  1. Pandanaboyana S, Moir J, Leeds JS, et al. SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study. Gut 2021 Feb 5:gutjnl-2020-323364. doi: 10.1136/gutjnl-2020-323364.
  2. gov.uk
  3. Müller JA, Groß R, Conzelmann C, et al. SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Nat Metab. 2021 Feb 3. doi: 10.1038/s42255-021-00347-1.
  4. de-Madaria E, Capurso G. COVID-19 and acute pancreatitis: examining the causality. Nat Rev Gastroenterol Hepatol. 2021 Jan;18(1):3-4. doi: 10.1038/s41575-020-00389-y.

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