Pancreatitis

Pancreatitis is inflammation of your pancreas. Your pancreas is an organ behind your stomach. It balances your blood sugar levels and makes enzymes that break down food into nutrients your body can use.

A temporary case of pancreatitis won’t affect these functions in the long term. But when the inflammation is constant, it can make your pancreas less efficient at helping with digestion and keeping your blood sugar in a healthy range.

Pancreatitis causes pain and swelling in your abdomen. Gallstones and heavy drinking are the most common causes. Treatment options depend on each case, but they range from nutritional support to surgery.

Types of pancreatitis

There are two types of pancreatitis:

• Acute pancreatitis: This is sudden inflammation of your pancreas. Most people get better within several days. More severe cases may take longer to heal.
• Chronic pancreatitis: This is long-term inflammation that damages your pancreas over time and gets worse. It creates scar tissue (fibrosis) that stops your pancreas from working normally.

Acute pancreatitis is fairly common compared to chronic pancreatitis. In the U.S., acute pancreatitis leads to around 275,000 hospital stays a year. Around 8 in 10 people leave the hospital after a few days.

Symptoms of pancreatitis

Symptoms of acute pancreatitis include:

• Pain that spreads from your abdomen to your back
• Fever
• Lightheadedness from low blood pressure
• Nausea and vomiting
• Rapid breathing and heart rate
• Swelling in your abdomen

In acute pancreatitis, the pain feels severe and constant. You might feel it deeply, too. Your abdomen can also feel tender to the touch.

Symptoms of chronic pancreatitis include:

• Upper abdominal pain
• Diarrhea
• Greasy stools (poops) that leave an oily film in the toilet
• Loss of appetite
• Nausea and vomiting
• Unintended weight loss

With chronic pancreatitis, the intensity of the pain can vary. Flare-ups can last from several hours to many days. But the pain never completely goes away. It may get worse when you:

• Lie flat
• Cough
• Exercise
• Eat heavier meals

As chronic pancreatitis progresses, the pain doesn’t go away. For some people, pain may become less severe as chronic pancreatitis gets worse. But this doesn’t mean your pancreas has healed.

Pancreatitis causes

The most common causes of pancreatitis are gallstones and heavy alcohol use.

When gallstones clog up your common bile duct, they keep your pancreas from draining digestive juices. These juices inflame your pancreas as they start to digest it. Gallstone pancreatitis is the most common cause of acute inflammation.

Consistently drinking too much alcohol for at least five years straight can also cause pancreatitis. But researchers are still working to understand why. It might be that lots of byproducts from alcohol in your blood can irritate your pancreas, or that they trigger digestive juices to eat away at the tissue.

Excess alcohol use is the most common cause of chronic pancreatitis. But it can lead to both types.

Other, less common causes include:

• Autoimmune disease (like in autoimmune pancreatitis)
• Complications of cystic fibrosis
• High calcium levels in your blood
• Infection from a virus
• Inherited gene mutations (like in hereditary pancreatitis)
• Some medications
• Traumatic injury to your pancreas
• Very high triglyceride levels

Risk factors

Risk factors for pancreatitis include:

• Smoking
• Heavy alcohol use
• Obesity and metabolic syndrome
• High blood triglyceride levels (hypertriglyceridemia)
• A biological family history of pancreatitis

Complications of pancreatitis

Both acute and chronic pancreatitis can cause complications.

A pancreatic fluid collection can form during or after pancreatitis. Some fluid collections may go away on their own. Others can become infected, press on nearby organs or need to be drained.

While most cases are mild, severe acute pancreatitis can lead to serious problems, like:

• Pancreatic necrosis: Part of the pancreas or nearby tissue begins to die and release fluids into your abdomen. Sometimes, this tissue can become infected.
• Infection: Bacteria take over dead tissue in your pancreas and make more of themselves. They can even infect your bloodstream, which is an emergency.
• Organ failure: Severe inflammation can affect your lungs, kidneys, heart or other organs. Some people may need care in an intensive care unit (ICU).

Chronic pancreatitis also causes complications, but they develop more slowly. They include:

• Exocrine pancreatic insufficiency (EPI): As scars replace healthy tissue, your pancreas makes less of the enzymes that break down food. Your body won’t be able to absorb nutrients properly. So, you’ll lose weight and develop chronic diarrhea.
• Diabetes: The damage in your pancreas keeps it from making the hormones your body needs to regulate your blood sugar levels. This type of diabetes is sometimes called pancreatogenic or Type 3c diabetes.
• A higher risk of pancreatic cancer: People with chronic pancreatitis have a higher risk of developing pancreatic cancer. But most people with chronic pancreatitis don’t develop cancer.

How doctors diagnose pancreatitis

Your healthcare provider will ask about your symptoms and medical history. They may also order tests.

For acute pancreatitis, diagnosis is usually based on a combination of:

• Typical upper abdominal pain
• High levels of pancreatic enzymes in your blood (especially lipase)
• Imaging that shows inflammation of your pancreas

You may not need imaging if your symptoms and blood tests clearly show acute pancreatitis.

For chronic pancreatitis, your provider may use:

• Blood tests
• CT scans
• MRI or MRCP
• Endoscopic ultrasound
• Tests that show how well your pancreas is making digestive enzymes

Your provider may also check your blood sugar and nutrition.

How is acute pancreatitis treated?

Treatment for acute pancreatitis depends on the cause and how severe it is. In some cases, it can go away on its own. But in the meantime, it can help you feel better to get supportive care in the hospital. This can include:

• Fluids: Pancreatitis can dehydrate you. Your care team will give you fluids through a vein in your arm to help your body heal.
• Pain medicine: Your care team will give you medicine to manage pain.
• Nutrition: If you’re having trouble eating, you may have a feeding tube placed through your nose or stomach to get enough nutrition. If your case is severe, you might get nutrition through a vein instead.
• Monitoring: Your care team will watch your breathing, kidneys, blood pressure and other body functions.
• Gallstone removal: If gallstones are blocking your pancreas from draining, your provider may remove the stone with an endoscope. They might also recommend gallbladder removal surgery to prevent any future problems with gallstones.

If a gallstone remains stuck in your bile duct or causes an infection called cholangitis, your provider may recommend a procedure called ERCP. During ERCP, a doctor can remove the blocked stone.

If you have complications, you may also need:

• Antibiotics
• Procedures to drain fluid or remove dead tissue
• Intensive care

How is chronic pancreatitis treated?

If you have chronic pancreatitis, you’ll get a referral to a specialist called a gastroenterologist. First, they’ll focus on managing the pain. Your care team may also include a surgeon, dietitian, pain specialist and other healthcare providers.

You may have to try many different medications and procedures to find something that works for you. Procedures that remove scarred tissue or stones near your pancreas, like ERCP and lithotripsy, could help. Another potential option is injecting nerves in the pancreas with pain-numbing medications (celiac plexus block).

Other treatments may include:

• Modifying daily habits: Eating low-fat foods, plenty of fruits and veggies, and staying hydrated can help slow the progression of chronic pancreatitis. If you drink alcohol or smoke, your provider can point you to resources to help you quit.
• Supplements and medication: If you develop exocrine pancreatic insufficiency (EPI), you’ll need to take pancreatic enzyme supplements. You may also need nutritional supplements. And if you develop diabetes, you’ll need insulin, too.
• Stopping alcohol and tobacco: Avoiding alcohol and smoking can help prevent more damage to your pancreas.
• Surgery: If severe inflammation is causing complications or unchecked pain, you may need surgery to drain a blocked pancreatic duct or remove part of your pancreas. Your provider may recommend removing your whole pancreas if it’s heavily damaged and still causes pain.

When should I seek care?

Go to the nearest emergency department if you have severe, constant abdominal pain, especially if you also have:

• Repeated vomiting
• Fever
• Trouble breathing
• Fainting or severe dizziness
• A fast heartbeat

Acute pancreatitis can become serious quickly, so don’t wait if your symptoms are severe.

Contact your healthcare provider if you have chronic pancreatitis and your symptoms are getting worse, you’re losing weight or your current treatment isn’t helping. They’ll want to take a closer look at what’s going on and find out what works for you.

What can I expect if I have pancreatitis?

Most people with acute pancreatitis make a full recovery. If your case is mild, you should feel better within several days. If your case is more severe or complex, you may need to stay in the hospital for several weeks.

But the chance of acute pancreatitis coming back is low once your pancreas has healed (around 5 in 100 people see it recur). Your risk depends on what caused the first attack and whether that cause has been treated. For example, removing the gallbladder after gallstone pancreatitis can greatly lower your risk of another gallstone-related attack.

Among the small percentage of people who experience organ failure, the mortality rate is around 1 in 5.

Chronic pancreatitis progresses slowly. With regular care, you can keep track of the condition and stay ahead of complications. Pain management can be challenging for some people, and it can take a toll on your mental health. If this is your situation, pancreas removal surgery might be an option.

Can pancreatitis be prevented?

You can’t prevent all causes of pancreatitis. But you can lower your risk by drinking alcohol in moderation. You can also reduce your risk of getting gallstones by cutting back on cholesterol.

If you’ve had acute pancreatitis and you smoke or drink alcohol, you can help prevent another episode by quitting.

Other ways to protect your pancreas include:

• Keep your triglyceride levels under control.
• Maintain a weight that’s healthy for you.
• Avoid losing weight too quickly.
• Eat a balanced diet with fruits, vegetables, whole grains and healthy fats.
• Take medicines as directed by your healthcare provider.