Pancreatitis

What is pancreatitis?

Pancreatitis is inflammation of your pancreas, a gland tucked behind your stomach that helps you digest food and control your blood sugar. It can come on suddenly and settle within days (acute pancreatitis) or persist and slowly worsen over years (chronic pancreatitis).

What are the symptoms of pancreatitis?

The main symptom of both forms is pain in your upper abdomen, which often spreads through to your back.

With acute pancreatitis, the pain typically:

• starts suddenly and does not go away, or comes on gradually
• is severe, sharp or knife-like
• affects the upper part of your abdomen, one side, or your whole abdomen
• feels worse after eating, moving around or lying flat
• feels better when you lean forward or curl up.

You may also have a high temperature, feel or be sick, a fast heartbeat, sweating, bloating, or a tender abdomen, and you'll usually look and feel seriously unwell.

With chronic pancreatitis, pain may come and go, or become constant. Some people have little or no pain at all, particularly once complications set in. Other symptoms can include:

• indigestion or pain that's worse after eating
• nausea and vomiting
• diarrhoea
• loss of appetite and unintended weight loss
• greasy, foul-smelling stools that may leave an oily film, from fat that hasn't been digested properly.

Seek emergency care for signs of severe pancreatitis, including pain spreading to your back with persistent or recurring bloating, a fast heartbeat or difficulty breathing, yellowing of your skin or the whites of your eyes (jaundice), or skin around your belly button, waist or upper thigh that looks blue or bruised, which may be harder to see on black or brown skin.

What are the causes of pancreatitis and who is at risk?

Gallstones and heavy alcohol use together account for around 80% of all cases, whether acute or chronic.

• gallstones can block the opening where the pancreas drains into your gut, trapping digestive enzymes inside it and triggering inflammation. This is the most common single cause of acute pancreatitis
• heavy alcohol use is the leading cause of chronic pancreatitis, and a common cause of acute pancreatitis too, though it's not fully understood why alcohol triggers it.

Less common causes include:

• certain medicines, including some steroids, heart and epilepsy medicines, some diabetes medicines, and water tablets (diuretics)
• high levels of fat (triglycerides) or calcium in your blood
• injury to your pancreas, including during surgery or a procedure to examine your bile or pancreatic ducts
• infections, such as mumps or certain viruses
• inherited or genetic disorders of the pancreas, including cystic fibrosis
• autoimmune disease, where your immune system attacks your pancreas
• pancreas divisum, a condition you're born with affecting the pancreatic ducts
• pancreatic cancer
• lupus
• high blood calcium.

You're more likely to develop pancreatitis if you drink heavily, smoke, or have type 2 diabetes. In many cases, especially with chronic pancreatitis, no clear cause is ever found.

Are there different types of pancreatitis?

There are two main types.

Acute pancreatitis is a temporary attack, usually as your pancreas recovers from a short-term injury. Most people recover fully within days to a couple of weeks with supportive care, though a small proportion of cases become severe and can cause serious, potentially life-threatening complications.

Chronic pancreatitis is a long-term, progressive condition that doesn't go away and gradually worsens, usually because the injury to your pancreas never fully stops. Constant inflammation eventually scars the pancreas (fibrosis), reducing its ability to produce enzymes and hormones. Repeated attacks of acute pancreatitis can, over time, lead to chronic pancreatitis.

How is pancreatitis diagnosed?

Pancreatitis is usually diagnosed quickly using a combination of an examination and blood tests that check for pancreatic enzymes; levels at least three times higher than normal strongly suggest pancreatitis. You'll usually also have an ultrasound, CT or MRI scan, which can show swelling around your pancreas, check for gallstones, and help confirm how severe the inflammation is.

If chronic pancreatitis is suspected, further tests may be used to check how well your pancreas is working, including a blood glucose test, a stool test for the enzyme elastase, a test for excess fat in your stools, and blood tests to check your nutrition and vitamin levels.

How is pancreatitis treated?

Acute pancreatitis

There's no specific cure for acute pancreatitis, but most people improve on their own within a week and can leave hospital within 5 to 10 days. You'll be given fluids through a drip to prevent dehydration, painkillers, and oxygen if needed. If you have mild pancreatitis without sickness or ongoing pain, you can usually eat normally; if not, you may need nutrition through a feeding tube, or rarely, directly into a vein.

If gallstones are causing your pancreatitis, you may need a procedure called ERCP, where a thin tube with a camera is passed down through your mouth to your gut to find and remove the stone, and your gallbladder will usually need to be removed too, ideally within about 2 weeks, to prevent further attacks. If you have an infection alongside your pancreatitis, you'll also need antibiotics.

Chronic pancreatitis

Treatment focuses on managing pain and protecting your remaining pancreatic function, alongside stopping alcohol and smoking completely, since both speed up damage to the pancreas.

• a low-fat diet, with plenty of water
• pain relief, which can be complex to manage and may need input from a pain specialist; some people benefit from a procedure to numb the nerves around the pancreas, or from removing scar tissue or stones from the pancreatic duct
• pancreatic enzyme tablets taken with food, if your pancreas is no longer making enough of its own
• insulin, if your pancreas stops producing enough to control your blood sugar
• nutritional supplements, if you're struggling to absorb enough nutrients from your food.

Surgery to remove the damaged part of your pancreas is sometimes used if severe, concentrated inflammation is causing unmanageable pain or complications. In advanced cases, removing the whole pancreas is occasionally considered; you can live without a pancreas, though you'll need insulin afterwards.

When should I see a doctor?

Ask for an urgent GP appointment or call NHS 111 if you have sudden, severe abdominal pain that doesn't go away or keeps coming back, alongside a high temperature or feeling hot, cold or shivery.

Call 999 or go to A&E if you have sudden, severe abdominal pain along with any of: pain spreading to your back, bloating that won't settle or keeps returning, a fast heartbeat or difficulty breathing, or blue or bruised-looking skin around your belly button, waist or upper thigh. Don't drive yourself; ask someone to take you, or call an ambulance.