Pancreatic disease

What is pancreatic disease?

'Pancreatic disease' is a broad term for conditions that affect your pancreas, the gland behind your stomach that produces digestive enzymes and hormones such as insulin. These conditions range from sudden, short-lived problems, such as acute pancreatitis, to long-term conditions such as chronic pancreatitis or pancreatic cancer.

What are the symptoms of pancreatic disease?

Symptoms depend on which condition you have, but commonly include:

• upper abdominal pain, which may spread to your back and can worsen after eating
• nausea and vomiting
• bloating and indigestion
• reduced appetite
• weight loss.

If your pancreas stops producing enough digestive enzymes, you may also notice:

• pale, greasy stools that are difficult to flush away
• diarrhoea, or an urgent need to open your bowels
• excess wind
• weight loss despite eating normally.

What are the causes of pancreatic disease and who is at risk?

Causes vary depending on the specific condition, but commonly include:

• gallstones, a common trigger for acute pancreatitis
• long-term heavy alcohol use, a common cause of chronic pancreatitis
• high levels of fat (triglycerides) in your blood
• smoking, which increases your risk of chronic pancreatitis and pancreatic cancer
• autoimmune conditions, where your immune system attacks your pancreas
• genetic and inherited factors
• certain medications, though this is rare.

Chronic pancreatitis is more common in people who drink heavily, though it can also occur in people who don't drink alcohol at all. It also raises your risk of pancreatic cancer to two to three times that of the general population.

Are there different types of pancreatic disease?

'Pancreatic disease' covers a number of different conditions, including:

• Acute pancreatitis: sudden inflammation of the pancreas, causing severe abdominal pain and needing urgent medical assessment.
• Chronic pancreatitis: long-term inflammation that leads to scarring and reduced digestive function over time.
• Pancreatic exocrine insufficiency (PEI): when your pancreas doesn't produce enough digestive enzymes, leading to poor absorption of nutrients and weight loss.
• Pancreatic cysts: fluid-filled sacs in or around the pancreas. Most are non-cancerous and simply need monitoring, though a few types carry a higher risk of turning cancerous.
• Pancreatic tumours: growths that can be non-cancerous or cancerous (pancreatic cancer).
• Diabetes related to pancreatic disease: some pancreatic conditions affect your body's ability to produce insulin and control blood sugar.

How is pancreatic disease diagnosed?

Your doctor will ask about your symptoms, pain pattern, alcohol intake, gallstone history, weight changes and bowel habits, and examine you for abdominal tenderness or signs of jaundice. They may then arrange:

• blood tests, to check your pancreatic enzymes (amylase or lipase), liver function, inflammation markers, kidney function, blood fats and blood sugar
• stool tests, in some cases, to check how well your pancreas is producing digestive enzymes
• an ultrasound scan, often used to look for gallstones or bile duct problems
• a CT scan, commonly used to assess pancreatitis and its complications
• an MRI or MRCP scan, to look at your pancreatic and bile ducts in detail
• endoscopic tests, where appropriate.

How is pancreatic disease treated?

Non-surgical treatment

Treatment depends on your specific diagnosis and how severe it is.

• Acute pancreatitis: usually needs hospital-based care, with pain relief, fluids given into a vein, monitoring, and treatment of the underlying trigger, such as gallstones.
• Chronic pancreatitis: pain management, dietary and nutritional support, and stopping alcohol and smoking, alongside treatment for any complications such as diabetes.
• Pancreatic exocrine insufficiency: pancreatic enzyme replacement therapy (capsules taken with meals), dietitian support, and monitoring for vitamin and mineral deficiencies.
• Pancreatic cysts: many can simply be monitored with regular scans rather than treated directly.

Surgical treatment

Surgery is considered for some conditions and complications, such as removing the gallbladder if gallstones are the underlying cause of your pancreatitis, or removing a pancreatic tumour or a cyst with concerning features.

If you have chronic pancreatitis, surgery is generally only considered once you've stopped drinking alcohol and smoking, if your specialist believes it will help.

When should I see a doctor?

Contact your doctor if you have persistent upper abdominal pain, unexplained weight loss, or greasy stools. Seek urgent medical help if you develop:

• severe, worsening upper abdominal pain, especially with vomiting
• fever, confusion, fainting or severe dehydration
• jaundice (yellowing of your skin or eyes), especially with abdominal pain or fever
• vomiting blood or passing black stools
• a sudden worsening of symptoms if you already have pancreatitis.