Pancreatitis

Pancreatitis is inflammation of the pancreas. There are two types of pancreatitis: acute – when the pancreas is inflamed and causes short-term illness – and chronic – when the pancreas is irreversibly damaged and causes ongoing, long-term illness or bouts of acute symptoms.

About pancreatitis

In the UK, up to 45,000 people are living with chronic pancreatitis and around 12,000 people get acute pancreatitis each year. If you have chronic pancreatitis, you may also get flare-ups of acute pancreatitis at the same time. Pancreatitis is more common in men than in women.

When describing an illness, the terms 'acute' and 'chronic' refer to how long you have had it, not to how serious the condition is. An acute illness is typically over quite quickly. A chronic illness is one that lasts a long time, maybe for the rest of your life.

The pancreas

Your pancreas is an organ about 15cm (six inches) long and is part of your digestive system. It's found just in front of your spine behind your stomach, at the level of your breastbone. It's connected to the top of your small bowel (duodenum) by a tube called the pancreatic duct.

Your pancreas produces digestive enzymes that help to break down food in your small bowel and insulin – a hormone that helps to keep the level of sugar in your blood constant.

Symptoms of pancreatitis

Acute pancreatitis can be a life-threatening illness with severe complications. Symptoms come on suddenly or develop over a few days, and may be worse after eating. Although the pain may be mild at first, it can become severe and may last continuously for a few days. Symptoms include:

• severe pain in your upper abdomen (tummy)
• loss of appetite
• feeling sick and vomiting
• a temperature higher than 37.5°C
• a swollen abdomen
• a rapid pulse

If acute pancreatitis is very severe, it may also lead to dehydration and a drop in blood pressure.

If the inflammation is severe or recurrent, your pancreas can be permanently damaged, leading to chronic pancreatitis. Symptoms of chronic pancreatitis are similar to those for acute pancreatitis, but the pain is likely to be less severe and you won’t have a fever. Additional symptoms of chronic pancreatitis include:

• pale-coloured, oily faeces
• weight loss (even though you’re eating normally) and tiredness

These symptoms aren't always caused by pancreatitis but if you have them, see your GP. You may need to seek urgent medical attention if your symptoms are severe. 

Complications of pancreatitis

Complications of acute pancreatitis can include:

• some of your pancreatic tissue dying, which can lead to an abscess
• fluid-filled cysts developing around your pancreas
• bleeding in your pancreas

Complications of chronic pancreatitis can include the above, as well as:

• type 1 diabetes
• a slightly increased risk of developing pancreatic cancer – see our frequently asked questions for more information
• malnutrition

Causes of pancreatitis

The most common causes of pancreatitis are:

• drinking excessive amounts of alcohol
• having gallstones (small pebble-like stones made of hardened bile) in your bile duct

Other causes include:

• certain medicines, such as sodium valproate, azathioprine, furosemide and corticosteroids
• abdominal injuries
• a tumour in your pancreas
• damage caused by surgery or endoscopy
• autoimmune problems
• a viral infection, such as mumps or the Epstein-Barr virus
• increased calcium or fat levels in your blood
• pancreas divisum – being born with ducts in your pancreas that don't function properly
• genetics – you may inherit a faulty gene from your parents (this is called hereditary pancreatitis)
• cystic fibrosis
• inflammation of the blood vessels in your pancreas or reduced blood flow to your pancreas

Acute pancreatitis can become chronic if pancreatic tissue is destroyed and scarring develops, or if the underlying cause, for example, drinking alcohol to excess, has not been managed. In some people who develop chronic pancreatitis, the cause isn’t known.

Diagnosis of pancreatitis

Symptoms of acute pancreatitis can be severe enough to require immediate hospital treatment. Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history, and about how much alcohol you drink.

You may have blood tests to check your levels of digestive enzymes as these can be at least three times the normal level if you have acute pancreatitis. You may have one or more of the following scans to check your pancreas, gallbladder, pancreatic duct and bile ducts.

• Abdominal ultrasound – this uses sound waves to produce images of the inside of your body.
• CT scan - this uses X-rays are used to make three-dimensional pictures of the inside of your body.
• Endoscopic ultrasound – a narrow, flexible, tube-like telescopic camera called an endoscope is passed down your throat, through your stomach and into your small bowel. An ultrasound sensor produces sound waves to create pictures of your pancreas and bile ducts. This procedure can sometimes trigger an attack of acute pancreatitis.
• Magnetic resonance cholangiopancreatography (MRCP) – this is an MRI scan that uses magnets and radio waves to produce images of the inside of your body. You will lie inside a cylinder-shaped scanner and a dye is injected into a vein that helps to show cross-section pictures of your pancreas and related organs, such as your gallbladder and bile ducts.

You may have other tests, especially if your doctor thinks you have chronic pancreatitis, such as a test to measure how much isn’t being absorbed by your gut.

Treatment of pancreatitis

Treatment of acute pancreatitis

Most people with acute pancreatitis need hospital treatment. Treatment usually consists of controlling pain, treating the inflammation and resting your pancreas until symptoms improve. To help your pancreas rest, you won’t be able to eat or drink for a few days so you will be given fluids, antibiotics and medicine for pain relief through a drip inserted into a vein in your hand or arm. Depending on the severity of your symptoms and any complications, you may need to stay in the intensive care unit (ICU) at the hospital. See our frequently asked questions for more information.

If you vomit, a tube may be placed through your nose into your stomach to remove fluids and air. If your condition is very severe, and especially if you’re losing a lot of weight, you may need to have nasogastric feeding – this is when a long, thin tube is inserted through your nose and throat into your stomach. The tube will deliver a special liquid into your stomach until your pancreas heals. It may also be used to help remove fluid and air, particularly if you continue to feel sick and vomit.

When your symptoms have improved, your doctor will do further tests to determine the cause and degree of damage to your pancreas.You may need surgery to remove your gallbladder if your symptoms are caused by gallstones. Surgery may be delayed until your symptoms have improved so that the risks associated with your operation are reduced.

Treatment of chronic pancreatitis

The treatment for chronic pancreatitis depends on what problems the condition is causing – this will vary from person to person. Wherever possible, treatment aims to correct the underlying cause, relieve pain, treat problems with food absorption and reverse weight loss.

In general terms, chronic pancreatitis is managed by trying to prevent future attacks, making lifestyle changes to reduce the risk of further damage to your pancreas and by treating the damage that has already been done.

Medicines

For chronic pancreatitis, your GP may prescribe the following medicines to help you manage your condition.

• Painkillers to relieve chronic pain.
• Synthetic pancreatic enzymes, such as pancreatin (eg Creon, Nutrizym, Pancrex), to replace the enzymes your pancreas can no longer make and to help reverse problems with absorption of fat.
• Insulin or other medicines to control your blood sugar level. If your pancreas isn't producing enough insulin, you may develop type 1 diabetes.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your GP or pharmacist for advice.

Surgery for chronic pancreatitis

Your doctor may recommend surgery if you have chronic pancreatitis, although this isn’t suitable for everyone. Operations that you may have include:

• draining the affected part of your pancreas
• draining cysts that have formed as a complication of chronic pancreatitis
• removal of the most damaged parts of your pancreas

Prevention of pancreatitis

You can help to prevent pancreatitis by eating a healthy diet and not drinking excessive amounts of alcohol. See our frequently asked questions for more information.

Living with pancreatitis

If you have a bout of acute pancreatitis or are diagnosed with chronic pancreatitis, you will need to make lifestyle changes to help manage your condition and prevent further attacks.

Your doctor will suggest you drink sensibly and eat a low-fat diet – a dietitian can help you to plan an appropriate diet. You may also need to take vitamin and enzyme supplements. If you have developed diabetes, your doctor will tell you about changes that you may need to make to your diet and how to measure your blood sugar.

Produced by Polly Kerr, Bupa Health Information Team, November 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.