Pancreatitis

Key points

• Pancreatitis means your pancreas is inflamed. This can happen suddenly or build up slowly over time.
• The main causes of pancreatitis are gallstones and regular alcohol consumption.
• Treatment for pancreatitis may include hospital care, pain relief, fluids, and treating the cause (for example, gallstones).

What is pancreatitis?

Your pancreas is an organ in your digestive system that sits just behind your stomach. It makes enzymes that help to break down the foods you eat. It also makes insulin, which helps to control the level of glucose (sugar) in your blood.

In pancreatitis, your pancreas becomes inflamed. This causes symptoms such as stomach pain. If it’s severe or lasts for a long time, it can also damage your pancreas and affect how well it works. Pancreatitis can be classed as acute or chronic.

• Acute pancreatitis comes on suddenly and usually lasts for a short time. Most people have a mild illness and will make a full recovery within a few days. Acute pancreatitis is usually a one-off illness, but sometimes it can come back, unless the cause is found and treated.
• Chronic pancreatitis is when your pancreas is inflamed over a long period of time. This causes ongoing damage and scarring, which affects how well your pancreas works. Chronic pancreatitis is a long-term condition that you’ll normally have for life.

Acute pancreatitis is more common than chronic pancreatitis. But both types are becoming more common in the UK.

What are the main causes of pancreatitis?

The main causes of pancreatitis are the following.

• Gallstones (hard lumps that develop in your gallbladder). These cause around half of all cases of acute pancreatitis.
• Regularly drinking a lot of alcohol. This causes around a quarter of cases of acute pancreatitis. It’s also the most common cause of chronic pancreatitis.

Certain other things can also increase your risk of developing pancreatitis. These include the following.

• Smoking – this can increase the risk of developing chronic pancreatitis or make it progress faster.
• Having a family history of pancreatitis. Genetic factors can play a part in chronic pancreatitis, especially if you develop it before you’re 35.
• Having a procedure or surgery that involves or is near your pancreas. This can cause acute pancreatitis.
• Certain metabolic conditions, including having high levels of fats or calcium in your blood.
• Certain infections that may affect your pancreas.
• Some medicines, including diuretics, statins and some types of antibiotic.
• Autoimmune conditions such as lupus or Sjögren’s syndrome.
• Having an underlying problem with the structure of your pancreas or how it works.

It’s not always possible to find a reason why someone has developed pancreatitis.

Pancreatitis symptoms

The main symptom for both acute and chronic pancreatitis is severe pain in your upper abdomen (tummy), which can spread to your back. The pain can get worse when you move, and feel better if you lean forward or curl into a ball. Sometimes it’s worse after eating.

What does pancreatitis pain feel like?

Some people describe the pain of acute pancreatitis as feeling like being stabbed with a knife. This is a severe pain that comes on suddenly. In chronic pancreatitis, you may have more of a dull pain. This can be constant or may come and go.

Acute pancreatitis symptoms

With acute pancreatitis, the pain comes on suddenly over a few hours then becomes constant.

Other acute pancreatitis symptoms include:

• feeling and being sick
• losing your appetite
• fever
• your abdomen feeling tender or swollen

Chronic pancreatitis symptoms

In chronic pancreatitis, you tend to get a dull, deep pain. It can be constant or it may come and go. Around 1 in 5 people with chronic pancreatitis don’t get any pain at all.

Other chronic pancreatitis symptoms include:

• feeling and being sick
• having pale, runny poo that smells bad and is difficult to flush away – this is known as steatorrhoea
• feeling bloated, getting tummy cramps and passing wind (farting) more often than usual
• losing weight
• developing yellow-coloured skin and a yellow tinge to the whites of your eyes (jaundice)

Contact your GP or call 111 for medical advice straight away if you develop severe pain in your abdomen.

Diagnosis of pancreatitis

Your doctor will ask about your symptoms and your medical and family history. They’ll want to know how much alcohol you drink. If your GP thinks you might have acute pancreatitis, you should be admitted to hospital straight away. You will have tests there to confirm a diagnosis. If your symptoms are thought to be due to chronic pancreatitis, your GP may arrange some tests or may refer you to a specialist doctor. As well as confirming a diagnosis, tests for pancreatitis can help identify a cause. This will help with treatment.

You may have some of the following tests.

• Blood tests to check for pancreatic enzymes or diabetes.
• An X-ray of your chest or abdomen (tummy). This can help identify a cause or rule out other problems.
• Imaging scans of your abdomen with CT or MRI.

Is pancreatitis serious?

Pancreatitis can be serious. Most people who get acute pancreatitis (where it comes on suddenly) have a mild illness and recover quickly. But severe acute pancreatitis or chronic pancreatitis can go on to cause complications. These can be serious.

Pancreatitis complications

Acute pancreatitis

Complications of acute pancreatitis include the following.

• Pancreatic necrosis. This is when some of the tissue in your pancreas dies and can become infected. This can be life-threatening if it’s not treated quickly. It may need treatment with antibiotics or a surgical procedure.
• Abscesses. These are collections of pus that can form in your abdomen, usually after a few weeks.
• Pseudocysts. These are fluid-filled cysts that can develop around your pancreas, a few weeks after the pancreatitis.

More severe cases of acute pancreatitis can lead to other problems around your body. These can include damage to your kidneys, an infection in your blood (sepsis), and problems with your breathing.

Chronic pancreatitis

Complications of chronic pancreatitis can develop over many years. Most people develop some complications eventually.

Complications of chronic pancreatitis include the following.

• Pseudocysts – fluid-filled cysts in your pancreas. These can be painful and can sometimes get infected.
• Problems with digesting or absorbing food, which can lead to malnutrition (not getting enough nutrients).
• Diabetes. This can develop because your pancreas can’t make the hormone insulin.
• Osteoporosis - weakened bones and increased risk of breaking a bone. This is a side-effect of not absorbing enough nutrients.
• Pancreatic cancer. Chronic pancreatitis may increase your risk of developing pancreatic cancer. The risk is greater if you have a genetic form of pancreatitis.

You will be advised to have regular screening for diabetes and osteoporosis if you have chronic pancreatitis.

Prevention of pancreatitis

If you’ve already had an episode of acute pancreatitis, there’s a risk that you may get another one. You may also go on to develop chronic pancreatitis. But there are things you can do to reduce the risk of this happening. These include the following.

• Reducing how much alcohol you drink – or preferably stopping drinking altogether.
• Eating a healthy, balanced, low-fat diet.
• Stopping smoking.
• If you have gallstones, having treatment to remove them.
• If you have high blood lipid levels, treatment to control them may help.