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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 74-78

Effect of Ayurvedic medicines in the management of acute recurrent pancreatitis: A case report


Central Council for Research in Ayurvedic Sciences, New Delhi, India

Date of Submission12-Jan-2022
Date of Acceptance05-Jul-2022
Date of Web Publication12-Oct-2022

Correspondence Address:
Dr. Hemanta K Panigrahi
Central Ayurveda Research Institute, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jras.jras_7_22

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  Abstract 

This case report presents the treatment outcome of a 9-year-old diagnosed case of acute recurrent pancreatitis (ARP). The patient has suffered recurrent severe abdominal pain, vomiting, and constipation for the past 3 years. The high amylase and lipase levels in the serum, ultrasonography, and magnetic resonance cholangiopancreatography findings confirmed the diagnosis of ARP. The patient regularly took allopathic medicines, yet she had recurrent abdominal pain episodes that required hospitalization. The patient was treated with Ayurveda medicines, including Kamadudha Rasa (Mukta Yukta), Agnitundi Vati (twice daily before meals), and Nityam tablet at bedtime for 3 weeks. In the third week, the treatment was modified by replacing Agnitundi Vati with Kravyad Rasa and Kankayana Vati. The 8-month continued therapy resulted in complete clinical recovery. No adverse reactions or untoward effects due to Ayurveda interventions were reported during the treatment. There was no recurrence after a 90-day follow-up. Based on the results obtained in this case study, a clinical trial on Ayurvedic management of ARP may be planned to prove the efficacy of Ayurveda treatment regimen in treating ARP empirically.

Keywords: Acute recurrent pancreatitis, Ayurveda, case report


How to cite this article:
Padhi MM, Panigrahi HK, Lavekar GS. Effect of Ayurvedic medicines in the management of acute recurrent pancreatitis: A case report. J Res Ayurvedic Sci 2022;6:74-8

How to cite this URL:
Padhi MM, Panigrahi HK, Lavekar GS. Effect of Ayurvedic medicines in the management of acute recurrent pancreatitis: A case report. J Res Ayurvedic Sci [serial online] 2022 [cited 2023 Feb 2];6:74-8. Available from: http://www.jrasccras.com/text.asp?2022/6/2/74/358304




  Introduction Top


Nicholas Tulp, a Dutch anatomist, first described acute pancreatitis in 1652.[1] The incidence of pancreatitis is about 8.9 million cases per year globally.[2] Around 25% of patients with acute pancreatitis develop severe acute pancreatitis (SAP), with a mortality incidence of 2–10%.[3] The incidence of the disease increases with age.[4],[5] Treatment of acute pancreatitis is a difficult challenge among medical practitioners due to its high recurrence rate. Acute recurrent pancreatitis (ARP) is a clinical condition characterized by recurrent episodes of acute pancreatitis. In a study on 319 cases of different variants of pancreatitis, Ayurveda drugs have provided complete relief and lowered the recurrence of acute episodes without causing any side effects.[6] In other words, Pitta pacifying drugs, as well as medicines that aid in the functioning of the Pitta Dosha, can be used to treat ARP. This case of ARP was successfully treated with Ayurvedic medicines, resulting in total remission of severe abdominal pain, vomiting, and constipation, as well as restoration of the elevated level of serum amylase and lipase.


  Patient Information Top


On February 4, 2021, a 9-year-old girl presented with complaints of abdominal pain and two to three episodes of vomiting. The patient had recurrent pain in the right hypochondrium and left side of the abdomen for the past 3 years. The patient had severe abdominal pain, nausea, vomiting, and restlessness that required hospitalization every 3–6 months. The patient also had a complaint of chronic constipation. She was prescribed to take tablets of a pancreatic enzyme 10,000 U twice a day with meals, as well as tablets of an antacid, a multivitamin, and an analgesic if she was in pain. Although the patient experienced symptomatic relief, the episodes recurred. There was no history of similar illness in the patient’s family.

Investigations in the past have included magnetic resonance cholangiopancreatography (MRCP), which was performed on June 11, 2019. The test revealed an entire, bulky pancreatic parenchyma, mild T2 hyperintense, non-dilated main pancreatic duct, with fat stranding around it, minimal peripancreatic collection, and patency of the Santorini duct with the impression of acute interstitial pancreatitis. Anti-transglutaminase IgG antibodies were reported negative on June 17, 2019. In previous investigations, the DNA test was also performed to assess hereditary pancreatitis on October 30, 2019. A heterozygous single base pair deletion in exon 4 of the SPINK 1 gene was noted, which is uncertain but significant. On August 21, 2020, the serum amylase was 653 U/L (normal 28–100 U/L), serum lipase was 925 U/L (normal 13–60 U/L), and C-reactive protein (CRP) was 13.36 U/L (normal <5 U/L). On December 17, 2020, the patient had acute pain in abdomen associated with vomiting episodes, and the serum amylase and lipase were reported upto 945 U/L, and 1381 U/L respectively. On December 21, 2020, the USG whole abdomen findings included bulky pancreas with peripancreatic fat stranding, which was suggestive of ARP.


  Clinical Findings Top


Clinical findings exhibited a slightly distended abdomen with tenderness over the umbilical area. The lymph nodes were not palpable, and no adventitious breath, heart, and bowel sounds were noted in auscultation.


  Timeline Top


The timeline of the case is described in [Table 1].
Table 1: Timeline of the studied case

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  Diagnostic Assessment Top


The diagnosis of ARP was done based on the previous findings of serum amylase, serum lipase, and USG abdomen. The detailed investigation reports are provided in [Table 2].
Table 2: Investigations

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  Therapeutic Intervention Top


All other treatments were stopped before beginning the Ayurveda treatment. On February 4, 2021, the patient was given Kamadudha Rasa (Mukta Yukta) 125 mg on empty stomach with honey twice a day, Agnitundi Vati 125 mg twice daily after meals, and Nityam tablet 125 mg at bedtime. Mahashankha Vati 125 mg was advised to be used in case of pain, and Eladi Vati was prescribed to be chewed in case of nausea/vomiting. This schedule was continued up to the 3rd week of July 2021. Though the episodic attacks became mild to moderate, and the severity of abdominal pain was less. The patient did not require hospitalization during this period. Still, the symptoms did not disappear completely, and an alternate Agnidipaka and Pachaka medicine was substituted in place of Agnitundi Vati. Accordingly, the treatment was modified by replacing Agnitundi Vati with Kravyada Rasa and Kankayan Vati 125 mg each. The patient was advised not to take hot, spices, oily foods, and fruits that taste sour. The patient was advised to take milk, Daliya, and papaya regularly.


  Follow-up and Outcomes Top


The follow-up was done every fortnight during treatment. The assessment of adherence to the intervention and treatment was done through consultation with the patient’s parents. The patient’s parents took the medicines at regular intervals and reported the progress along with test reports of laboratory investigations. The patient’s parents were also asked about the need of rescue medicines in case of pain or nausea. Although the patient experienced recurrent mild pain after taking Ayurvedic remedies till the 3rd week of July, she did not require hospitalization. The Ayurvedic treatment was modified on July 3, 2021, as mentioned before. Later on, the patient had not suffered from any complaints. On September 16, 2021, the patient was asymptomatic, with normal serum amylase and lipase, and no fat stranding was observed in the USG of the abdomen. For the next 90 days, the patient’s follow-up was done telephonically every 15 days. The patient has not reported any complaints or side effects during this period. The details of the investigations before and after treatment are depicted in [Table 2].


  Discussion Top


The goal of the treatment, in this case, was to correct abnormalities in pancreatic cells by lowering the inflammatory process and attenuation of fat around the pancreas, which was caused by an unknown reason.

Kamadudha Rasa is an Ayurveda formulation used in the treatment of Amalpitta (~hyperacidity), Pittajvikara (~diseases of the Pitta Dosha), Jirnajwara (chronic fever), and Shotha (inflammation).[7],[8] The pancreas is a site of Pitta Dosha, and vitiated Pitta can be a cause of ARP in this case. The vitiated Pitta can also lead to inflammation. The oral administration of Kamadudha Rasa could have helped in pacifying the vitiated Pitta and reduce the inflammatory changes in the pancreas. From the Ayurveda perspective, it is claimed that relieving constipation or cleansing the intestine by using laxatives is a necessary step to treat inflammation. Nityam tablet was prescribed based on this view. Nityam tablet is a formulation used as a laxative and indicated for abdominal discomfort, flatulence, and constipation.

Agnitundi Vati has actions such as Agni Deepak (~orexigenic or appetizer), Amapachaka (~digest Ama), Vatashamaka (pacifies VataDosha), and Shoolaghna (analgesic).[9],[10] In the laboratory investigation of this case, fat stranding was noted surrounding the main pancreatic duct, with minimal peripancreatic collection and patency of the Santorini duct. AgnitundiVati was chosen by assuming that Amapachaka action[11] can help remove the fat stranding and fluid around the pancreas. The effect observed till the 3rd week of July indicated the assumption that the Amapachaka action was helpful; however, the action was slow, and thus significant relief was not observed. Therefore, it was decided to use Kravyada Rasa and Kankayan Vati, which have action similar to that of Agnitundi Vati, but the potency is comparatively high. Kankayan Vati also possesses Vatanulomaka (~act like a mild laxative), anti-inflammatory, analgesic, and anti-spasmodic actions, which were also expected in the present case to relieve constipation.[12],[13] The modification in the treatment by prescribing Kravyada Rasa and Kankayan Vati in place of Agnitundi Vati resulted in complete relief.

The positive effect of the treatment, as mentioned earlier, was evident from the USG findings, which revealed no fat stranding surrounding the pancreas and serum amylase and lipase in the reference range. As the patient’s age was 9 years, the dose was decided considering the disease’s severity and the patient’s body weight. All the medicines were well tolerated since the patient or her parents did not report any adverse effects during the entire course of treatment. In addition, complete remission of signs and symptoms was there. The hereditary pancreatitis, in this case, was not firmly established as the presence of a heterozygous single base pair deletion in exon 4 of the SPINK 1 gene was uncertain. The absence of a similar disease condition in the patient’s family history ruled out the possibility of hereditary pancreatitis. Therefore, the exact cause of pancreatitis cannot be firmly established in this case. However, this study is a case report, and thus it has limitations in generalizing the results. A randomized controlled clinical trial on a sufficient number of participants is required to establish the role of Ayurveda interventions in treating ARP.


  Conclusion Top


Administration of Kamadudha Rasa (Mukta Yukta), Kravyad Rasa, Kankayan Vati, and Nityam tablets effectively treat ARP. During the treatment period, no adverse effects and symptom relapse were noted, ensuring the safety and efficacy of the prescribed medicines. Further clinical trials are required to validate the results.

Patient’s guardian perspective

After receiving Ayurvedic treatment, our daughter is completely relieved. Her condition has substantially improved since then. Our daughter had been hospitalized three times in the preceding year before starting the Ayurvedic treatment. We are delighted with the changes in her physical condition that the Ayurveda treatment has brought.

Declaration of patient consent

A written informed consent was obtained from the guardian of the patient for publication of this case report.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Pannala R, Kidd M, Modlin IM Acute pancreatitis: A historical perspective. Pancreas 2009;38:355-66.  Back to cited text no. 1
    
2.
Theo V, Christine A, Megha A, Ryan BM, Zulfiqar BA, et al. A systemic analysis for the Global Burden of Disease Study. Lancet 2015;388:1545-602.  Back to cited text no. 2
    
3.
Fagenholz PJ, Castillo CF, Harris NS Increasing United States hospital admissions for acute pancreatitis. Ann Epidemiol1988;177:491-8.  Back to cited text no. 3
    
4.
Yadav D, Lowenfels AB Trends in the epidemiology of the first attack of acute pancreatitis: A systematic review. Pancreas 2006;33:323-30.  Back to cited text no. 4
    
5.
Toouli J, Brooke-Smith M, Bassi C, Carr-Locke D, Telford J, Freeny P, et al; Working Party of the Program Committee of the Bangkok World Congress of Gastroenterology 2002. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol 2002;17(Suppl):S15-39.  Back to cited text no. 5
    
6.
Prakash VB, Prakash S, Sharma S, Tiwari S Impact evaluation of Ayurvedic treatment protocol on three hundred nineteen cases of different variants of pancreatitis. Pancreat Disord Ther 2018;8:196. doi:10.4172/2165–7092.1000196  Back to cited text no. 6
    
7.
Thakur Singh N Rastantrasaar and Siddha Prayog Sangraha-Prathama Khanda. 19th ed. Ajmer, Rajasthan, India: Krishna Gopal Ayurved Bhawan (Dharmartha Trust); 2015.  Back to cited text no. 7
    
8.
Zade RR, Pendse VK, Rajput DS Review article of Rasaushadhi described in Bhaishjya Ratnavali for the treatment of Amalpitta (hyperacidity). J Indian Syst Med 2015;3:191-6.  Back to cited text no. 8
    
9.
Tripathi B Sharangadhar-Samhita. 3rd ed. Varanasi: Acharya Sharangdhara Surbharati Prakashan; 1998. p. 311.  Back to cited text no. 9
    
10.
Gabhane SM Clinical evaluation of Agnitundi Vati in management of Gridhrasi with special reference to sciatica. Int J Ayur Med 2020; 11:76-80.  Back to cited text no. 10
    
11.
Pargotra PP, Thakur B Ayurvedic approach in management of Amavata w.s.r. to rheumatoid arthritis. IJAPR2018;6:40-5.  Back to cited text no. 11
    
12.
Borkar KM, Shekokar AKV, Patange V A clinical study of Kankayan vati in the management of arsha (piles). Int J Ayur Med 2012;3:177-81.  Back to cited text no. 12
    
13.
Kaviraj DS, Govind . Bhaisajya Ratnavali. In:Mishra S, editor. Agnimandhyaadi Chikitsa Prakarana: Verse 215–220. Varanasi: Chaukhamba Surbharati Prakashan; 2013.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
Patient Information
Clinical Findings
Timeline
Diagnostic Asses...
Therapeutic Inte...
Follow-up and Ou...
Discussion
Conclusion
References
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