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Pancreatitis


Expert reviewer Mr Stephen Pollard, Consultant Surgeon
Next review due March 2019

Pancreatitis is a condition when your pancreas (an organ in your digestive system) becomes inflamed. It can last for a short time and get better (acute), or for a long time and get gradually worse (chronic). If your pancreas is inflamed for a long time, it becomes damaged and stops working properly. Pancreatitis can be very painful.

The most common cause of pancreatitis is drinking too much alcohol. Gallstones can also cause acute pancreatitis.


An image showing the liver and surrounding structures

Types of pancreatitis

Your pancreas is about 15cm (six inches) long and is located just behind your stomach. 

Your pancreas produces proteins called enzymes, which help to break down the foods you eat. It also produces insulin, which is a hormone that helps to control the level of glucose (sugar) in your blood.

There are two main types of pancreatitis: 

  • Acute pancreatitis comes on suddenly and is usually a one-off illness, after which your pancreas returns to normal.
  • Chronic pancreatitis is when your pancreas becomes inflamed over and over again. This causes scarring and gradually affects how well your pancreas works. If you have chronic pancreatitis, your pancreas doesn’t get better, which means you will have an ongoing, long-term illness.

In the UK, around 50 in 100,000 people are diagnosed with acute pancreatitis every year. Around 6 to 9 in 100,000 people in the UK are diagnosed with chronic pancreatitis each year.

Symptoms of pancreatitis

The symptoms of acute pancreatitis can vary from mild to very severe. The symptoms often come on suddenly or develop over a few days.

The main symptom of acute pancreatitis is abdominal (tummy) pain. The pain is usually in the top middle or top left of your abdomen and over time it becomes constant and may be severe. The pain can spread to your back and the side of your abdomen and can get worse when you move. 

Other symptoms of acute pancreatitis include:

  • losing your appetite
  • feeling sick and vomiting
  • a fast heartbeat 

If you have chronic pancreatitis, you’ll also have abdominal pain. The pain is usually dull and may get worse around half an hour after you eat. Sitting forwards can reduce the pain.

Other symptoms of chronic pancreatitis include:

  • pale-coloured, oily faeces
  • losing weight
  • feeling sick and vomiting
  • symptoms of diabetes, such as feeling very thirsty and needing to urinate more frequently 

Sometimes chronic pancreatitis starts with several attacks of acute pancreatitis. Chronic pancreatitis can then develop years later.

If you have any of these symptoms, see your GP. If your symptoms are severe, get medical help straight away. Severe acute pancreatitis can be life-threatening.

Diagnosis of pancreatitis

Symptoms of acute pancreatitis can be so severe that you may need hospital treatment straight away. Your doctor will ask about your symptoms and examine you. They may also ask you about your medical history, and about how much alcohol you drink.

You may need to have some of the following tests if your doctor thinks your symptoms may be caused by pancreatitis. 

  • Blood tests – these are necessary to confirm your diagnosis if you have acute pancreatitis.
  • Urine tests.
  • An X-ray of your chest and abdomen (tummy).
  • An abdominal ultrasound – this may show whether your pancreas is inflamed or not.
  • A CT scan.
  • A type of MRI scan called a magnetic resonance cholangiopancreatogram (MRCP). This can show damage to your pancreas and also show any gallstones, which can cause pancreatitis.
  • Endoscopic retrograde cholangiopancreatography (ERCP). This technique produces a detailed X-ray of your pancreas and bile ducts. Your doctor will use a special dye and a narrow, flexible, tube-like telescopic camera called an endoscope to do this test. The camera can show gallstones and equipment can be passed through the endoscope to remove them. ERCP can sometimes trigger an attack of acute pancreatitis.

If your doctor thinks you may have chronic pancreatitis, they may also want to test your faeces, to see if it contains fat, proteins and certain enzymes, which can be signs of pancreatitis.

Treatment of pancreatitis

Treatment of acute pancreatitis

If you have severe acute pancreatitis, you’re likely to need treatment in hospital. Your treatment will depend on how severe the pancreatitis is and what’s causing it. 

Most people with acute pancreatitis find that their symptoms get much better within a week of starting treatment. However, if your pancreatitis is severe, it can cause other organs in your body to stop working. If this happens, you’ll need to be treated in intensive care or on a high dependency unit.

Resting your pancreas

Treatment for acute pancreatitis aims to control your pain, ease other symptoms such as sickness, and prevent or reduce the chance of complications. This means ‘resting’ your pancreas and bowel. Your doctor may treat you with all, or some, of the following:

  • intravenous fluids given by a drip, through a vein in your arm
  • painkillers – these may include medicines called opiates (for example, morphine) if your pain is severe
  • medicines to treat sickness 

To help your pancreas ‘rest’, you won’t be able to eat or drink for a few days, so you may be given liquid food through a tube instead. To do this, a long, thin tube is put up your nostril and passed down your throat into your stomach or small bowel. A special liquid food can then be put straight into your stomach or bowel until your pancreas heals and you can eat and drink again.

Your pancreas produces the hormone insulin, which controls the level of glucose (sugar) in your blood. When your pancreas is inflamed it stops working properly and doesn’t produce enough insulin. You’re likely to need insulin injections or an infusion given into your vein instead.

Gallstone treatment

If your pancreatitis is caused by gallstones, you’ll need to have them removed. This can be done either by having your gallbladder removed (a cholecystectomy), or during a procedure using endoscopic retrograde cholangiopancreatography (ERCP). In ERCP, the gallstones are removed using an endoscope (a narrow flexible tube), which is passed down your throat.

Treatment of chronic pancreatitis

The treatment for chronic pancreatitis depends on what’s causing it and what your symptoms are. Treatment aims to ease your symptoms and pain, to help you to stay well, and to treat the cause of your pancreatitis or pain, if it’s known.

Lifestyle changes

If you’re diagnosed with chronic pancreatitis, you’ll probably be asked to make some changes to your lifestyle, to prevent complications from developing. These include stopping smoking and cutting your alcohol intake right down – or stopping drinking alcohol altogether. If your pancreatitis is caused by drinking too much alcohol, then stopping drinking can also help to reduce your pain.

You may be asked to make changes to your diet and to take supplements, such as antioxidants. Some people with chronic pancreatitis may also need to have liquid foods. A long, thin tube is put up your nostril and passed down your throat into your stomach or small bowel. A special liquid food can then be put straight into your stomach or bowel. 

Medicines

Your doctor may prescribe the following medicines to help you manage your condition. 

  • Painkillers – the type of painkiller you doctor prescribes will depend on how severe your pain is. If you have severe pain, your doctor may arrange for you to see a specialist team of health professionals who help people to manage and live with long-term pain.  
  • Synthetic pancreatic enzymes, such as pancreatin – these medicines replace the enzymes that your pancreas can no longer make.

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

Surgery

Depending on what’s causing your pancreatitis and your level of pain, your doctor may suggest an operation; although surgery isn’t an option for everyone. Your surgeon may remove or drain any cysts, or remove part of your pancreas. This can help to treat complications and can also help to reduce your pain.

Causes of pancreatitis

The most common cause of pancreatitis is drinking too much alcohol. Gallstones can also cause acute pancreatitis.

There are other possible causes for acute pancreatitis, such as cancer of the pancreas, injury or infection. Some medicines, for example some diuretics (water tablets) and the antibiotic tetracycline, can also cause acute pancreatitis.

You may get chronic pancreatitis if your pancreas becomes inflamed over and over again. This causes scarring and gradually affects how well your pancreas works. In some people, chronic pancreatitis may be inherited (you have a gene passed down from your parents, which puts you at greater risk of developing the disease).

For some people with pancreatitis, the exact cause is never found.

Complications of pancreatitis

Most people with acute pancreatitis feel much better, and their symptoms start to improve, within a week of starting treatment. However, around one in five people have severe pancreatitis which can cause serious complications. These can include:

  • a painful infection (an abscess)
  • cysts filled with fluid which develop around your pancreas
  • kidney failure – severe pancreatitis can also affect how well other organs work

Complications of chronic pancreatitis can develop over many years and most people will develop a problem related to this condition eventually. You will need long-term treatment and care from a team of health professionals to prevent complications from developing wherever possible.

Complications can include:

  • fluid-filled cysts in your pancreas, which can be painful and can sometimes burst
  • your pancreas stops working as well as it should, which means that it can’t produce important proteins called enzymes – if this happens, you will need to take supplements
  • type 1 diabetes – this can develop because your pancreas can’t produce insulin.  

If you have severe pain, or pain over a long period of time, you can become addicted to strong painkillers. Your doctor will work with you to reduce the likelihood of this happening. There is also a small chance of developing cancer of the pancreas if you have chronic pancreatitis. You can find out more about this in our FAQs.

Frequently asked questions

  • The longer you’ve had chronic pancreatitis, the more likely you are to develop cancer of the pancreas. Your risk of developing cancer will also depend on your age and what has caused your chronic pancreatitis. Your risk is higher if you have inherited a gene that causes chronic pancreatitis. You’re also at greater risk if your pancreatitis has been caused by drinking too much alcohol. Drinking too much alcohol also makes you more likely to develop pancreatic cancer at a younger age.

  • Some people with chronic pancreatitis find their symptoms improve over time, while others have periods where their symptoms remain stable then get worse (flare up). But although chronic pancreatitis can be treated, it can't be cured.

    Once your pancreas is damaged, it won’t work properly again. The inflammation that develops in chronic pancreatitis gradually damages your pancreas and causes scar tissue to build up. This affects how well your pancreas works. This is why it's important to get the right treatment as quickly as possible to prevent complications.

  • This will depend on how severe your pancreatitis is and whether it’s acute or chronic.

    Most people with acute pancreatitis are treated in hospital, rather than by their GP. If you have chronic pancreatitis, your GP may be able to manage your care. They will need to refer you to a specialist if you have a flare up or develop problems. 

    Specialist health professionals you may see include:

    • gastroenterologists – doctors who specialise in treating conditions that affect the stomach and bowels
    • pain specialists who can help you to control pain in the long term
    • addiction services to give you support if your pancreatitis is caused by drinking too much alcohol

    You may be treated by a specialist team of health professionals or referred to a specialist centre. There are several specialist centres in the UK where you can be cared for by a team of doctors, nurses and other health staff who are experts in treating the condition. The Pancreatitis Supporters' Network has a list of centres on their website.


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Related information

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    • Chronic pancreatitis. BMJ Best Practice. www.bestpractice.bmj.com, published October 2015
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    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 19 December 2015
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  • Reviewed by Pippa Coulter, Bupa Health Content Team, March 2016
    Expert reviewer Mr Stephen Pollard, Consultant Surgeon
    Next review due March 2019



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