Overview – Chronic pancreatitis

Acute pancreatitis is sudden swelling and inflammation of the pancreas.

Acute pancreatitis

Acute pancreatitis is sudden swelling and inflammation of the pancreas.

Causes

The pancreas is an organ located behind the stomach. It produces the hormones insulin and glucagon. It also produces chemicals called enzymes needed to digest food.

Most of the time, the enzymes are active only after they reach the small intestine.

If these enzymes become active inside the pancreas, they can digest the tissue of the pancreas. This causes swelling, bleeding, and damage to the organ and its blood vessels.
This problem is called acute pancreatitis.

Acute pancreatitis affects men more often than women. Certain diseases, surgeries, and habits make you more likely to develop this condition.

Alcohol use is responsible for up to 70% of cases in the United States. About 5 to 8 drinks per day for 5 or more years can damage the pancreas.
Gallstones are the next most common cause. When the gallstones travel out of the gallbladder into the bile ducts, they may block the opening that drains bile and enzymes. The bile and enzymes “back up” into the pancreas and cause swelling.
Genetics may be a factor in some cases. Sometimes, the cause is not known.

Other conditions that have been linked to pancreatitis are:

Autoimmune problems (when the immune system attacks the body)
Damage to the bile ducts or pancreas during surgery
High blood levels of a fat called triglycerides — most often above 1,000 mg/dL
Injury to the pancreas from an accident

Other causes include:

After certain procedures used to diagnose gallbladder and pancreas problems (endoscopic retrograde cholangiopancreatography, ERCP) or ultrasound guided biopsy
Cystic fibrosis
Overactive parathyroid gland
Reye syndrome
Use of certain medicines (especially estrogens, corticosteroids, sulfonamides, thiazides, and azathioprine)
Certain infections, such as mumps, that involve the pancreas

Symptoms

The main symptom of pancreatitis is pain felt in the upper left side or middle of the abdomen. The pain:

May be worse within minutes after eating or drinking at first, more commonly if foods have a high fat content
Becomes constant and more severe, lasting for several days
May be worse when lying flat on the back
May spread (radiate) to the back or below the left shoulder blade

People with acute pancreatitis often look ill and have a fever, nausea, vomiting, and sweating.

Other symptoms that may occur with this disease include:

Clay-colored stools
Bloating and fullness
Hiccups
Indigestion
Mild yellowing of the skin and whites of the eyes (jaundice)
Swollen abdomen

Exams and Tests

The health care provider will do a physical exam, which may show:

Abdominal tenderness or lump (mass)
Fever
Low blood pressure
Rapid heart rate
Rapid breathing (respiratory) rate

Lab tests that show the release of pancreatic enzymes will be done. These include:

Increased serum amylase level
Increased serum lipase level (a more specific indicator of pancreatitis than amylase levels)
Increased urine amylase level

Other blood tests that can help diagnose pancreatitis or its complications include:

Complete blood count (CBC)
Comprehensive metabolic panel

The following imaging tests that can show swelling of the pancreas may be done, but are not always needed to make a diagnosis of acute pancreatitis:

CT scan of the abdomen
MRI of the abdomen
Ultrasound of the abdomen

Treatment

Treatment often requires a stay in the hospital. It may involve:

Pain medicines
Fluids given through a vein (IV)
Stopping food or fluid by mouth to limit the activity of the pancreas. In the past, patients did not get food for many days. However, feeding the digestive tract is an important treatment for pancreatitis, therefore a feeding tube may be put into the stomach or intestine until you can eat by mouth again.

A tube may be inserted through the nose or mouth to remove the contents of the stomach. This may be done if vomiting and severe pain do not improve. The tube will stay in for 1 to 2 days to 1 to 2 weeks.

Treating the condition that caused the problem can prevent repeated attacks.

In some cases, therapy is needed to:

Drain fluid that has collected in or around the pancreas
Remove gallstones
Relieve blockages of the pancreatic duct

In the most severe cases, surgery is needed to remove damaged, dead or infected pancreatic tissue.

Avoid smoking, alcoholic drinks, and fatty foods after the attack has improved.

Outlook (Prognosis)

Most cases go away in a week or less. However, some cases develop into a life-threatening illness.

The death rate is high when:

Bleeding in the pancreas has occurred.
Liver, heart, or kidney problems are also present.
An abscess forms the pancreas.
There is death or necrosis of larger amounts of tissue in the pancreas.

Sometimes the swelling and infection do not fully heal. Repeat episodes of pancreatitis may also occur. Either of these can lead to long-term damage of the pancreas (called chronic pancreatitis).

Possible Complications

Pancreatitis can return. The chances of it returning depend on the cause, and how well it can be treated. Complications of acute pancreatitis may include:

Acute kidney failure
Long-term lung damage (due to adult respiratory distress syndrome or ARDS)
Buildup of fluid in the abdomen (ascites)
Fluid collections in the pancreas (pancreatic pseudocysts) that may become infected (pancreatic abscess)
Heart failure

When to Contact a Medical Professional

Contact your provider if:

You have intense, constant abdominal pain.
You develop other symptoms of acute pancreatitis.

Prevention

You may lower your risk of new or repeat episodes of pancreatitis by taking steps to prevent the medical conditions that can lead to the disease:

DO NOT drink alcohol if it is the likely cause of the acute attack.
DO NOT smoke. Tobacco smoking can worsen acute and chronic pancreatitis.
Make sure children receive vaccines to protect them against mumps and other childhood illnesses.
Treat medical problems that lead to high blood levels of triglycerides.

Alternative Names

Gallstone pancreatitis; Pancreas – inflammation

Patient Instructions

Images

Digestive system
Endocrine glands
Pancreatitis, acute – CT scan
Pancreatitis – series

References

Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN. American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on initial management of acute pancreatitis. Gastroenterology. 2018;154(4):1096-1101. PMID: 29409760 pubmed.ncbi.nlm.nih.gov/29409760/.

Forsmark CE. Pancreatitis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 130.

Tenner S, Vege SS, Sheth SG, et al. American College of Gastroenterology Guidelines: management of acute pancreatitis. Am J Gastroenterol. 2024 1;119(3):419-437. Epub 2023 Nov 7. PMID: 38857482. pubmed.ncbi.nlm.nih.gov/38857482/.

Van Buren G, Fisher WE. Acute and chronic pancreatitis. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn’s Current Therapy 2024. Philadelphia, PA: Elsevier; 2024:175-182.

Vege SS. Acute pancreatitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 58.

Review Date 12/31/2023

Updated by: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria – Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Learn how to cite this page

Overview – Chronic pancreatitis

The pancreas is a small organ, located behind the stomach, that helps with digestion.

Chronic pancreatitis can affect people of any age. It is more common in men.

It’s different from acute pancreatitis, where the inflammation is only short term.

Most people with chronic pancreatitis have had 1 or more attacks of acute pancreatitis.

Symptoms of chronic pancreatitis

The most common symptom of chronic pancreatitis is repeated episodes of severe pain in your tummy (abdomen).

The pain usually develops in the middle or left side of your tummy and can move along your back.

It’s been described as a burning or shooting pain that comes and goes, but may last for several hours or days.

Although the pain sometimes comes on after eating a meal, there’s often no trigger. Some people might feel sick and vomit.

As the condition progresses, the painful episodes may become more frequent and severe.

Eventually, a constant dull pain can develop in your tummy, between episodes of severe pain.

Advanced chronic pancreatitis

Other symptoms develop as the damage to the pancreas progresses and it becomes unable to produce digestive juices, which help to break down food.

The absence of digestive juices means it’s harder to break down fats and some proteins. This can cause your poo to become very smelly and greasy, and make it difficult to flush down the toilet.

The pancreas usually only loses these functions many years after the first symptoms started.

You may also experience:

weight loss
loss of appetite
yellowing of the skin and eyes (jaundice)
symptoms of diabetes – such as feeling very thirsty, needing to pee more often than usual and feeling very tired
ongoing nausea and sickness (vomiting)

When to get medical advice

See a GP immediately if you’re experiencing severe pain, as this is a warning sign that something is wrong.

If this is not possible, contact NHS 111 for advice.

You should also see a GP as soon as you can if:

your skin or the whites of your eyes turn yellow (jaundice)
you keep being sick

Jaundice can have a range of causes other than pancreatitis, but it’s usually a sign there’s something wrong with your digestive system.

Diagnosing chronic pancreatitis

A GP will ask about your symptoms and may examine you.

They’ll refer you to a specialist for further tests if they think you have chronic pancreatitis.

The specialist will be able to confirm whether you have the condition.

Tests

Tests and scans are usually carried out in your local hospital.

They may include:

an ultrasound scan – where sound waves are used to create a picture of your pancreas
a CT scan – where a series of X-rays are taken to build up a more detailed 3D image of your pancreas
an endoscopic ultrasound scan – where a long, thin tube containing a camera is passed through your mouth and down into your stomach to take pictures of your pancreas
magnetic resonance cholangiopancreatography (MRCP) – a type of MRI scan that takes a detailed image of your pancreas and the organs around it

Biopsy

Sometimes the symptoms of chronic pancreatitis can be very similar to pancreatic cancer.

You may need a biopsy, where a small sample of cells is taken from the pancreas and sent to a laboratory to be checked, to rule this out.

Causes of chronic pancreatitis

The most common cause of chronic pancreatitis is drinking excessive amounts of alcohol over many years.

This can cause repeated episodes of acute pancreatitis, which results in increasing damage to the organ.

In children the most common cause is cystic fibrosis.

Less common causes include:

smoking
the immune system attacking the pancreas (autoimmune chronic pancreatitis)
inheriting a faulty gene that stops the pancreas working properly
injury to the pancreas
gallstones blocking the openings (ducts) of the pancreas
radiotherapy to the tummy

In some cases, no cause can be identified. This is called idiopathic chronic pancreatitis.

Treatment for chronic pancreatitis

The damage to the pancreas is permanent, but treatment can help control the condition and manage any symptoms.

People with chronic pancreatitis are usually advised to make lifestyle changes, such as stopping drinking alcohol and stopping smoking. They’re also given medicine to relieve pain.

Surgery may also be an option for those experiencing severe pain.

Complications

Living with chronic pain can cause mental as well as physical strain.

See a GP if you’re experiencing stress, anxiety or depression caused by chronic pancreatitis.

Some people with chronic pancreatitis will eventually develop a type of diabetes known as type 3c diabetes.

This occurs when the pancreas can no longer produce insulin because it’s become so damaged.

People with chronic pancreatitis can sometimes develop sacs of fluid on the surface of their pancreas (pseudocysts). These can cause bloating, indigestion and dull tummy pain.

These cysts often disappear on their own. But sometimes they need to be drained using a technique called endoscopic ultrasound drainage, or endoscopic transpapillary drainage.

Chronic pancreatitis increases your risk of pancreatic cancer, although the chance is still small.

Support for people living with chronic pancreatitis

Any long-term health condition, particularly one that causes recurring episodes of pain or constant pain, can affect your emotional and psychological health.

See a GP if you’re experiencing psychological and emotional difficulties. There are medicines available that can help with stress, anxiety and depression.

Talking to other people with the same condition can often reduce feelings of isolation and stress.

The charity Guts UK, may be able to put you in touch with a local support group.

Page last reviewed: 26 May 2022
Next review due: 26 May 2025

Pain Under Left Rib Cage After Eating

Overview – Chronic pancreatitis

Acute pancreatitis

Causes

Symptoms

Exams and Tests

Treatment

Outlook (Prognosis)

Possible Complications

When to Contact a Medical Professional

Prevention

Alternative Names

Patient Instructions

Images

References

Review Date 12/31/2023

Related MedlinePlus Health Topics

Overview – Chronic pancreatitis