Pancreatitis

Pancreatitis is when your pancreas becomes inflamed, which can stop it working properly. There are two types of pancreatitis – acute and chronic.

About pancreatitis

Your pancreas is about 15cm (six inches) long and sits just behind your stomach. It’s part of your digestive system and it makes enzymes which help to break down the foods you eat. It also makes insulin, which helps to control the level of glucose (sugar) in your blood.

Severe acute pancreatitis and chronic pancreatitis can both damage your pancreas and stop it working properly.

Globally the number of people with pancreatitis is going up. Acute pancreatitis is more common than chronic pancreatitis.

Types of pancreatitis

There are two main types of pancreatitis.

• Acute pancreatitis usually comes on suddenly and can vary from mild to severe. About eight out of 10 people with acute pancreatitis will have it mildly and will make a full recovery after a few days. Acute pancreatitis is usually a one-off illness, but sometimes it can come back.
• Chronic pancreatitis is when your pancreas is constantly inflamed. It is like a slow burn in the pancreas that lasts for a number of years. The inflammation can last longer in people who continue to smoke. This causes scarring which affects how well your pancreas works. Chronic pancreatitis isn’t likely to get better, which means that if you have this condition, you’ll have an ongoing, long-term illness. Men are more likely to develop chronic pancreatitis than women.

Symptoms of pancreatitis

Acute pancreatitis

The main symptom of acute pancreatitis is usually severe abdominal (tummy) pain. The pain is often in the top middle or top left of your abdomen and is constant. It can spread to your back, get worse when you move, and feel better when you curl into a ball. Some people say it feels like being stabbed with a knife.

Other symptoms of acute pancreatitis include:

• feeling sick and being sick
• losing your appetite
• a fast heartbeat, which may happen because you’re in pain

Chronic pancreatitis

If you have chronic pancreatitis, you’re likely to have a dull abdominal pain. The pain can spread through to your back and may get worse around half an hour after you eat. Sitting or leaning forwards can sometimes ease the pain.

Other symptoms of chronic pancreatitis include:

• pale, runny poo that smells bad and is difficult to flush away
• feeling bloated and passing wind often
• losing weight
• feeling sick and being sick
• yellow coloured skin and yellow tinge to the whites of your eyes (jaundice)

The symptoms of chronic pancreatitis can come and go. Some people have periods of time when they have no symptoms, whereas for others the pain is there all the time.

If your symptoms come on quickly and are severe, get medical help straight away because pancreatitis can sometimes cause serious illness. If you have any of the symptoms listed above and are concerned, speak to your doctor.

Diagnosis of pancreatitis

Finding the cause of pancreatitis is important so that preventative treatment or advice can be given. Your doctor will ask about your symptoms, your medical history, and how much alcohol you drink. They’ll examine you and carry out some basic tests such as checking your pulse rate and blood pressure.

If your doctor thinks your symptoms could be caused by pancreatitis, you may need to have some of the following investigations.

• Blood tests (for example, to test for pancreatic enzymes or diabetes).
• An X-ray of your chest or abdomen (tummy). This can help to show if anything else is causing your symptoms.
• An abdominal ultrasound. This uses sound waves to produce pictures of your organs and can help to show what may be causing your pancreatitis – for example, gallstones.

If your symptoms don’t get better or your doctor needs to rule out other conditions, you may need other investigations such as a CT scan.

Treatment of pancreatitis

Acute pancreatitis

If you have 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 find that their symptoms get much better within a week of starting treatment. But, if your pancreatitis is severe, it can cause other organs – for example, your kidneys – to stop working. If this happens, you’ll need to be treated in intensive care or a high dependency unit.

The main aim of treatment is to prevent or reduce the chance of complications and serious illness from developing. Your doctor will also treat your pain and ease any other symptoms such as sickness. You’ll probably be asked not to eat anything for a day or so. This helps your bowel to ‘rest’ by reducing the amount of digestive enzymes made. That will give your pancreas chance to recover.

The main treatments you’re likely to have for acute pancreatitis include:

• 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 any sickness
• insulin injections or an insulin infusion given into your vein

Gallstones

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

Chronic pancreatitis

The treatment for chronic pancreatitis depends on what your symptoms are and if you have any complications. The main aims of your treatment are to:

• ease your symptoms and pain
• help you stay as well as possible
• manage any complications
• improve your quality of life

You’re likely to have your care at a hospital but your doctor may share some of this care. You may be treated by a specialist team of health professionals including a gastroenterologist, dietician and pain specialist.

Lifestyle changes

If you smoke or drink alcohol, you’ll probably be asked to stop. Doing this can sometimes help to reduce pain. Giving up smoking or drinking can be difficult without the right support, so your doctor will help you. You may be referred to your local stop-smoking services or to a specialist alcohol service.

Your doctor or dietician may also suggest making some changes to the foods you eat. When you have pancreatitis, your body can’t get as much of the nutrients and energy out of your food as it should. Being in pain and feeling less like eating can also affect your weight. So, your doctor is likely to suggest eating five or six meals a day that are high in protein and energy to keep your body well supplied.

Medicines

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

• Painkillers. The type of painkiller your doctor prescribes will depend on how severe your pain is and whether it’s coming and going or always there. You may be offered paracetamol and ibuprofen along with a stronger painkillerl. Your doctor may also suggest taking a small amount of antidepressant or a painkiller that works for nerve pain because these can work well. If your pain is severe, you may be prescribed an opioid painkiller such as morphine.  
• Pancreatic enzyme supplements, such as pancreatin. These can ease pain and help you to digest food better so you get more nutrients from the foods you eat.

If you have any questions, ask your doctor or pharmacist for advice.

Surgery

If you have certain complications from pancreatitis or your pain doesn’t get better with other treatments, your doctor may suggest an operation to treat the underlying cause.

These procedures could include:

• draining any cysts that develop on your pancreas
• putting in a tube to help bile to drain properly
• removing or destroying gallstones or stones in your pancreas
• removing parts of your pancreas that are inflamed or damaged

Surgery isn’t a treatment choice for everyone. Your doctor will be able to advise you on the best treatment option for your circumstances.

Causes of pancreatitis

Gallstones are the main cause of acute pancreatitis and around half of all people with the condition have them. Drinking too much alcohol is the other main cause.

The most common cause of chronic pancreatitis is drinking too much alcohol. If you smoke and eat lots of high fat foods, you’re also more likely to develop chronic pancreatitis.

Complications of pancreatitis

Acute pancreatitis

Most people with acute pancreatitis find their symptoms improve and they feel better within a week of starting treatment. However, if you have severe pancreatitis, it can cause serious complications, such as:

• kidney failure
• an infection in your blood (sepsis)
• problems with your breathing and getting enough oxygen into your body
• an abscess
• fluid-filled cysts which develop around your pancreas

Chronic pancreatitis

Complications can develop over many years and most people develop them eventually. You’ll 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 – these can be painful and can sometimes get infected
• your pancreas stops making the enzymes that help to digest food – if this happens, you’ll need to take supplements
• diabetes – this can develop because your pancreas can’t make the hormone insulin

There is also a small chance of developing cancer of the pancreas. For more information on this, see our FAQ: Does chronic pancreatitis lead to pancreatic cancer?

Living with pancreatitis

Chronic pancreatitis can be a difficult condition to live with, and it can have a big impact on your day-to-day life especially if your symptoms are severe. So, it’s important to get help and support for you and your family.

Many people with the condition have pain all the time, and periods of time when that pain is severe. Sometimes, it can be difficult to manage and you may need to be referred to a specialist pain clinic. Constant pain can affect your mood as well as how you feel physically, so you need to look after your mental health too. It’s important to get support which helps you to manage day to day and when things are difficult.  

You might find it helpful if your doctor refers you to a pancreas specialist to help you manage your condition.