Pancreatitis

What is pancreatitis?

Pancreatitis is inflammation in your pancreas. Inflammation causes swelling and pain. If you have pancreatitis, it might feel like stomach pain that spreads to your back.

Your pancreas is an organ in your abdomen. It sits between your stomach and your spine. If you lay your right hand across your stomach, that's roughly the size and shape of your pancreas behind it.

Your pancreas is involved in digestion and regulating your blood sugar. It makes digestive enzymes (like amylase) and hormones (like insulin). It delivers digestive enzymes to your small intestine through the pancreatic duct.

Inflammation is your immune system’s response to injury. It’s supposed to help heal injured tissues. When your pancreas is injured, it’s most often from gallstones blocking the pancreatic duct, or from alcohol.

What are the different types of pancreatitis?

There are two types of pancreatitis: acute and chronic.

Acute pancreatitis

Acute pancreatitis is a temporary condition. It happens when your pancreas is attempting to recover from a minor, short-term injury. Most people with acute pancreatitis will recover completely in a few days with supportive care: rest, hydration and pain relief. However, a very severe case of acute pancreatitis can cause serious health complications, some of them life-threatening.

Chronic pancreatitis

Chronic pancreatitis is a long-term, progressive condition. It doesn’t go away and gets worse over time. It happens when the injury or damage to your pancreas never stops. Chronic pancreatitis will eventually do lasting damage to your pancreas, although it may take many years. Constant inflammation causes scarring of your pancreas tissues (fibrosis), which stops them from making enzymes and hormones.

How common is pancreatitis?

In the U.S., acute pancreatitis leads to 275,000 hospital stays per year. About 20% of these cases are considered severe. Chronic pancreatitis is less common and leads to 86,000 hospital stays per year.

What are the symptoms of pancreatitis?

The primary symptom of pancreatitis is abdominal pain.

Additional symptoms of acute pancreatitis may include:

• Nausea and vomiting.
• Fast heart rate.
• Fast, shallow breathing.
• Fever.

Additional symptoms of chronic pancreatitis may include:

• Indigestion and pain after eating.
• Loss of appetite and unintended weight loss.
• Fatty poops that leave an oily film in the toilet.
• Lightheadedness (from low blood pressure).

These are symptoms of your pancreatic functions beginning to break down.

What does the pain of pancreatitis feel like?

Abdominal pain from pancreatitis may be moderate to severe and may radiate to your back. Acute pancreatitis tends to be more severe, with a penetrating quality. Your abdomen may feel tender to the touch. With chronic pancreatitis, the pain may vary in intensity. It may come and go, but it typically doesn’t go away completely. You may notice it more after eating. For some people, the pain is constant.

It may feel worse when you:

• Lie flat.
• Cough.
• Exercise.
• Eat more.

It may feel better when you:

• Sit upright.
• Lean forward.
• Curl in a ball.
• Eat less.

What symptoms indicate that your pancreas isn’t working properly?

When long-term, chronic pancreatitis begins to affect your pancreatic function, you’ll notice it in your digestive system first. When your pancreas can no longer make and deliver its digestive enzymes, your body won’t be able to break down and absorb all the nutrients from your food. You may feel discomfort after eating and may begin passing undigested fats in your poop. Over time, you may notice weight loss.

What are the most common causes of pancreatitis?

The top two causes of pancreatitis are:

• Gallstones.
• Heavy drinking.

These causes together represent about 80% of pancreatitis cases.

Gallstone pancreatitis

Your common bile duct empties bile from your gallbladder into your intestine through the same opening as your pancreatic duct. If a gallstone enters the common bile duct and gets stuck at that junction, it can temporarily block the drainage of pancreatic juice from the pancreatic duct. This traps the enzymes inside your pancreas. As pressure builds up behind the obstruction, it activates the enzymes inside your pancreas and they begin digesting the pancreas itself. This causes the inflammatory response of gallstone pancreatitis.

Alcohol use

Heavy alcohol use is another clear cause of pancreatitis, though scientists aren’t sure why. It may be that the toxic byproducts of alcohol in your blood cause an inflammatory response in your pancreas, or they somehow chemically activate the digestive enzymes inside your pancreas. Scientists estimate that heavy alcohol use accounts for around half of both acute pancreatitis and chronic pancreatitis cases.

Other causes

Less common causes of pancreatitis include:

• Infections, such as viruses.
• Autoimmune disease (autoimmune pancreatitis).
• Inherited gene mutations (hereditary pancreatitis).
• Complications of cystic fibrosis.
• High blood triglyceride levels (hypertriglyceridemia).
• High blood calcium levels (hypercalcemia).
• Ischemia (reduced blood supply).
• Cancer.
• Traumatic injury to your pancreas.
• Certain medications that irritate the pancreas.

These causes together represent about 20% of pancreatitis cases. Occasionally, no cause is found.

Do acute and chronic pancreatitis have the same causes?

Most of the time, pancreatitis is acute and temporary. But causes that are chronic and don’t go away, such as inherited disorders, can cause chronic pancreatitis. Repeat episodes of acute pancreatitis can also lead to chronic pancreatitis. If your pancreas becomes inflamed too many times from repeated stress and injury, your body may learn to keep it constantly inflamed, even after the injury has stopped.

Can you die from pancreatitis?

You can die from complications of acute pancreatitis if it’s very severe. In a small percentage of people, severe acute pancreatitis causes a systemic reaction that affects the whole body. This can lead to shock and multiple organ failure, which can be fatal if it isn’t treated quickly. You may not be able to tell how severe your pancreatitis is, so you should go to the emergency room if you have symptoms.

What are the possible complications of pancreatitis?

Most cases of acute pancreatitis don’t have complications, but 1 in 5 cases is more severe. It’s not clear why severe acute pancreatitis occurs in some cases and not others. A severe case can lead to serious complications, including death. Chronic pancreatitis also causes complications, but they develop more slowly and aren’t directly life-threatening. Most complications are manageable with treatment.

Acute pancreatitis

Complications of severe acute pancreatitis include:

• Necrosis and infection. One in 3 cases of severe acute pancreatitis causes so much swelling in your pancreas that it cuts off some of the blood supply. The loss of blood supply causes tissue death (necrosis) in parts of your pancreas. Necrotic (dead) tissue is a feast for roaming bacteria. When bacteria infect these tissues, they thrive and replicate, spreading to your bloodstream. Infection in your bloodstream (septicemia) is an emergency. Your body reacts to an infection in the bloodstream by activating an immune response against the infection (systemic inflammatory response syndrome, or SIRS). This immune response can cause your blood vessels to enlarge, which leads to a drop in blood pressure (septic shock) and decreased blood flow to your vital organs. This can cause multiple organ failure.
• Pancreatic pseudocysts. Inflammation in your pancreas can disrupt the pancreatic duct that feeds pancreatic juices to your intestine. This can cause pancreatic juices to leak out around the pancreas and cause inflammation of the surrounding tissue. Over time, the inflamed area forms a hardened capsule around the fluid, called a pseudocyst. Many pseudocysts don’t cause symptoms or need treatment. But they can occasionally become infected or become large enough to cause discomfort. Rarely, a blood vessel can erode into a pseudocyst and lead to bleeding inside the cyst. In these cases, your healthcare provider may need to intervene to drain the cyst or stop the bleeding.
• Chronic pancreatitis. Repeat episodes of acute pancreatitis can lead to chronic pancreatitis. Constant inflammation in your pancreas eventually leads to scarring of the tissues (fibrosis). Fibrosis in your pancreas interferes with its ability to function as a gland. Over time, it produces less and less of the enzymes and hormones your body needs, leading to further complications.

Chronic pancreatitis

Complications of chronic pancreatitis develop over time and can include:

• Exocrine pancreatic insufficiency (EPI), malabsorption and malnutrition. As fibrosis in your pancreas progresses, your pancreas produces less and less of the enzymes that your digestive system relies on. This causes the malabsorption of nutrients in your small intestine, especially fats and fat-soluble vitamins. Excess fats pass through your poop, causing fatty stools and eventually, chronic diarrhea. As you absorb less nutrition from your food, you could begin to lose weight and eventually feel the effects of the missing nutrients.
• Hypoglycemia, hyperglycemia and Type 1 diabetes. Chronic pancreatitis will also cause your pancreas to produce less of the hormones that regulate your blood sugar (glucose). Depending on which is affected first, you may experience symptoms from a lack of glucagon, which causes hypoglycemia (low blood sugar), or from a lack of insulin, which causes hyperglycemia (high blood sugar). Eventually, both hormone supplies are depleted, and diabetes develops.
• Chronic pain. While some people with chronic pancreatitis don’t experience pain or experience a remission of pain over time, others experience worsening pain that’s eventually constant. It can be challenging to manage, even with medication, and can affect your mental health, as well.
• Increased risk of pancreatic cancer. Chronic inflammation is a risk factor for cancer wherever it occurs. In people with chronic pancreatitis, the risk of pancreatic adenocarcinoma is between 1% and 2%. Symptoms are similar to those of chronic pancreatitis, so they might go unnoticed. Doctors recommend that people with chronic pancreatitis have regular cancer screening.

How is pancreatitis diagnosed?

If you have characteristic symptoms of pancreatitis, a healthcare provider will check your pancreas with blood tests and imaging tests. A pancreas blood test looks for elevated levels of pancreatic enzymes in your blood. If levels are at least three times higher than normal, your provider will suspect pancreatitis. They might confirm the diagnosis with a cross-sectional imaging test, such as a CT scan or MRI. These tests can show swelling and fluid deposits in your pancreas as well as other abnormalities.

If your provider suspects you have chronic pancreatitis, they may order additional tests, including:

• Glucose test (to see whether your pancreas is still producing insulin effectively).
• Stool elastase test (to see if your pancreas is making enough digestive enzymes).
• Fecal fat analysis (to test for excess fat in your poop, a sign of fat malabsorption).
• Blood tests (to assess your nutritional status and whether you have enough fat-soluble vitamins in your blood).

How is pancreatitis treated?

Treatment depends on the cause, whether it’s acute or chronic and how severe it is. In general, you should always see a healthcare provider for symptoms of pancreatitis. Although some cases of acute pancreatitis may go away on their own, that depends on what caused the condition and how severe it is. In the meantime, most people with acute pancreatitis will need pain relief to get through it. Some people will need emergency treatment for certain causes. And some will need intensive care for complications.

Acute pancreatitis

Treatment for acute pancreatitis may include:

Supportive care

If the cause has been resolved and you don’t have severe or complicated pancreatitis, care will focus on supporting your body’s natural healing process. This usually includes:

• IV fluids. Pancreatitis is dehydrating, and hydration is very important for healing.
• Tube feeding. If you’re unable to tolerate food by mouth, your doctors may administer food via a tube placed through your nose or stomach to help you get enough nutrition.
• Parenteral nutrition: In very severe cases, your doctors may elect to provide nutrition through an intravenous line.
• Pain relief. You’ll have medication through an IV directly to your bloodstream or by mouth.

Gallstone removal

If you have gallstone pancreatitis, your provider may need to remove an impacted gallstone from your bile ducts. They’ll also recommend gallbladder removal surgery to prevent gallstones from causing you future problems. Procedures may include:

• Endoscopic retrograde cholangiopancreatography (ERCP). This procedure goes inside your bile ducts with an endoscope — a thin, flexible catheter with a camera attached. Most gallstones in your bile ducts can be removed this way. The endoscope passes down your throat and through your esophagus into your stomach and bile ducts. It sends images to a monitor. Watching the monitor, the endoscopist can insert tools through the catheter to remove gallstones.
• Gallbladder removal surgery. Once gallstones have brought you to the hospital, the chance of them causing you trouble again is high. Gallbladder removal is the standard treatment for gallstones that cause complications. It can usually be done through minimally invasive (laparoscopic) surgery. A laparoscopic cholecystectomy removes your gallbladder through a few small incisions, using the aid of a laparoscope, and a tiny camera is inserted through one of the incisions. Some people may require traditional open surgery depending on their condition.

Additional support

If you have complications, you may also need:

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

Chronic pancreatitis

If you have chronic pancreatitis, your general healthcare provider may refer you to a specialist (gastroenterologist). Treatment for chronic pancreatitis begins with pain management and lifestyle changes to slow down the progression of the disease. Eventually, you may need enzyme supplements and insulin injections to replace the enzymes and insulin your pancreas no longer produces.

Lifestyle changes

If you have chronic pancreatitis, it’s paramount that you quit drinking alcohol and quit smoking. These factors both contribute greatly to pancreatitis and will speed up the progression of the disease. Your healthcare provider can connect you with resources to help you quit. It’s also important to maintain a low-fat diet with plenty of fruits and vegetables and to drink plenty of water each day.

Pain management

Long-term pain management can be complex. You may need to experiment with a variety of different medications and procedures to find what works for you. Make sure to stay in touch with your healthcare provider about your pain, especially if what you’re doing isn’t working. They can refer you to a chronic pain specialist to help you manage your pain. In some cases, endoscopic procedures to remove scar tissue or pancreas stones may improve your symptoms. Injection of local anesthetic agents into the nerves of the pancreas (celiac plexus block) is another option for selected patients.

Supplements

Over time, many people with chronic pancreatitis can develop exocrine pancreatic insufficiency (EPI). These people will need to take pancreatic enzymes in supplement form. You might also need to take nutritional supplements to get enough calories and micronutrients (vitamins and minerals). Some people will develop glucose intolerance and eventually diabetes, becoming insulin-dependent.

Surgery

If severe inflammation is concentrated in a specific part of your pancreas and that part is causing unmanageable pain or complications, your provider might suggest surgery to remove that part of your pancreas (resection). In very advanced cases, when your pancreas has been severely damaged and still causes significant pain, they might recommend removing the whole pancreas (total pancreatectomy).

How can I prevent pancreatitis?

Not all causes are preventable, but you can reduce your risk by moderating your alcohol consumption. You can reduce your risk of gallstones, the other leading cause, by reducing cholesterol. If you’ve had acute pancreatitis, you can help prevent it from happening again by quitting alcohol and smoking. If you’ve had gallstone pancreatitis, removing your gallbladder can prevent it from recurring.

What is the long-term outlook for pancreatitis?

Most people recover completely from acute pancreatitis. If it’s not a severe case, you’ll feel better in five to 10 days. In severe or complicated cases, you may need to stay in the hospital for several weeks. If you’re able to avoid what caused your acute pancreatitis in the future, chances are good it won’t occur again. Among the small percentage of people who experience organ failure, the mortality rate is 20%.

Chronic pancreatitis is a slow-progressing disease. With regular care, you can keep track of its progression and stay ahead of its complications. Pain management can become a challenge for some people, and it can also affect your mental health and quality of life. When this is the case, surgery might be an option. You can live without your pancreas, although it may make you insulin-dependent.

A note from Cleveland Clinic

You may not think much about your pancreas, until one day it starts hurting. This can be a frightening and stressful way for the organ to grab your attention. Hopefully, it’ll be a one-time event. When you experience symptoms, head to the hospital. Most cases of acute pancreatitis are over in days. If you know what caused it, and you can avoid it, you probably won’t need a second warning to do so.

Chronic pancreatitis may come on more gradually and may take longer to notice. While some causes, such as alcohol use, are predictable, others are unusual and unexpected. You may have never imagined you were at risk of developing a chronic disease. Regardless, learning to live with it can be challenging. You’ll need a healthcare provider you can trust to help you manage it over the course of your life.