Pancreatitis: Symptoms, Causes & Treatment

What Is Pancreatitis?

Pancreatitis is inflammation of the pancreas, an organ located behind the stomach that produces digestive enzymes and hormones like insulin. When the pancreas becomes inflamed, digestive enzymes activate prematurely and begin to damage the pancreatic tissue itself, causing pain and other symptoms.

The pancreas plays two vital roles in the body. First, it produces digestive enzymes that help break down food in the small intestine, particularly fats, proteins, and carbohydrates. Second, it produces hormones including insulin and glucagon that regulate blood sugar levels. When pancreatitis occurs, both of these functions can be affected, leading to digestive problems and potentially diabetes.

Pancreatitis can present in two distinct forms: acute pancreatitis, which develops suddenly and typically resolves within days to weeks with proper treatment, and chronic pancreatitis, which is a progressive condition where repeated episodes of inflammation cause permanent scarring and damage to the pancreas over months to years.

The incidence of acute pancreatitis has been increasing globally, affecting approximately 30-40 people per 100,000 population annually in developed countries. Chronic pancreatitis is less common, affecting 5-12 per 100,000 population. Both conditions can affect people of any age, though acute pancreatitis is most common in adults between 30 and 70 years of age.

Acute vs. Chronic Pancreatitis

Understanding the difference between acute and chronic pancreatitis is essential for proper management and prognosis. Acute pancreatitis represents a sudden inflammatory episode where the pancreas can often recover completely if the underlying cause is addressed. In contrast, chronic pancreatitis involves irreversible structural damage that progressively impairs pancreatic function.

With acute pancreatitis, symptoms come on suddenly and are often severe. Most patients experience intense abdominal pain that may require hospitalization. However, with appropriate treatment and removal of the causative factor (such as gallstones), the pancreas can heal completely without permanent damage in most cases.

Chronic pancreatitis develops gradually, often over many years of repeated acute episodes or continuous exposure to damaging factors like alcohol. The ongoing inflammation leads to fibrosis (scarring) of the pancreatic tissue, which progressively destroys the cells that produce digestive enzymes and insulin. This damage is permanent and cannot be reversed, though its progression can be slowed.

What Are the Symptoms of Pancreatitis?

The main symptoms of pancreatitis include severe pain in the upper abdomen that often radiates to the back, nausea and vomiting, fever, rapid pulse, and abdominal tenderness. Pain typically worsens after eating, especially fatty foods. In chronic pancreatitis, weight loss, oily stools, and eventually diabetes may develop.

The hallmark symptom of pancreatitis is abdominal pain, which typically occurs in the upper middle or left side of the abdomen. This pain is often described as a constant, deep, piercing sensation that may radiate through to the back, between the shoulder blades. Many patients find that the pain worsens when lying flat on the back and may be partially relieved by leaning forward or curling into a fetal position.

The severity of pain varies considerably between patients and between episodes. In acute pancreatitis, the pain usually comes on suddenly and reaches maximum intensity within 30 minutes to an hour. It may persist for several days even with treatment. The pain often begins or worsens shortly after eating, particularly after consuming fatty or greasy foods, or after drinking alcohol.

Beyond pain, pancreatitis causes a constellation of symptoms related to the inflammatory process and its effects on the digestive system. Nausea and vomiting are extremely common, occurring in over 80% of patients with acute pancreatitis. The vomiting may be persistent and severe, contributing to dehydration that requires intravenous fluid replacement.

Symptoms of Acute Pancreatitis

Acute pancreatitis typically presents with a sudden onset of symptoms that can be quite dramatic. Patients often describe feeling severely ill within a matter of hours. The key symptoms include:

• Severe upper abdominal pain - Often described as a constant, boring pain that may radiate to the back
• Nausea and vomiting - Persistent, often not relieved by vomiting
• Fever - Usually around 38°C (100.4°F), may be higher with infection
• Rapid pulse (tachycardia) - Heart rate above 100 beats per minute
• Abdominal tenderness and distension - Belly feels tender and may be swollen
• Reduced bowel sounds - The intestines may slow down or stop temporarily

In severe cases, additional symptoms may develop indicating complications. These include a rapid drop in blood pressure (shock), difficulty breathing due to fluid accumulation around the lungs, and in some cases, bluish discoloration around the navel (Cullen's sign) or on the flanks (Grey Turner's sign), which indicate internal bleeding.

Symptoms of Chronic Pancreatitis

Chronic pancreatitis symptoms develop more gradually and evolve as the disease progresses. Initially, patients experience recurrent episodes of abdominal pain similar to acute pancreatitis, though often less severe. Over time, as more pancreatic tissue is destroyed, different symptoms emerge:

• Recurrent or constant abdominal pain - Pain typically worsens after eating or drinking alcohol
• Weight loss - Despite eating normally, patients lose weight due to poor nutrient absorption
• Steatorrhea (oily stools) - Pale, bulky, foul-smelling stools that may float and be difficult to flush
• Diabetes mellitus - Develops as insulin-producing cells are destroyed
• Jaundice - Yellowing of skin and eyes if the bile duct becomes obstructed

Interestingly, as chronic pancreatitis progresses and more of the pancreas is destroyed, pain may actually decrease. This phenomenon, sometimes called "burned-out pancreatitis," occurs because the nerves carrying pain signals are also destroyed. However, this comes at the cost of severe digestive problems and diabetes.

What Causes Pancreatitis?

Gallstones and heavy alcohol consumption are the two most common causes, together responsible for 70-80% of acute pancreatitis cases. Other causes include high triglycerides, certain medications, infections, abdominal trauma, and genetic factors. In 10-15% of cases, no cause can be identified (idiopathic pancreatitis).

Understanding the cause of pancreatitis is crucial for both treatment and prevention of future episodes. While the mechanisms differ slightly depending on the cause, the end result is the same: premature activation of digestive enzymes within the pancreas itself, leading to self-digestion of pancreatic tissue and inflammation.

Gallstones are the single most common cause of acute pancreatitis, responsible for approximately 40% of cases. When a gallstone passes through the bile duct and becomes lodged at the ampulla of Vater (where the pancreatic duct and bile duct meet before entering the small intestine), it blocks the flow of pancreatic secretions. This blockage increases pressure within the pancreatic duct and triggers enzyme activation within the pancreas itself.

Alcohol is the second most common cause of acute pancreatitis and the leading cause of chronic pancreatitis, accounting for 60-70% of chronic cases. The exact mechanism by which alcohol damages the pancreas is complex and not fully understood, but it involves multiple pathways including direct toxic effects on pancreatic cells, increased enzyme secretion, and obstruction of small pancreatic ducts by protein plugs.

Major Causes of Pancreatitis

Gallstones (Biliary Pancreatitis)

Gallstones form in the gallbladder from crystallization of bile components, primarily cholesterol. Small gallstones or "sludge" (tiny particles) can migrate from the gallbladder into the common bile duct and obstruct the pancreatic duct. Women, people over 40, those with obesity, and individuals with rapid weight loss are at higher risk for gallstones. The good news is that once gallstones are removed (usually by surgery to remove the gallbladder), the pancreatitis typically does not recur.

Alcohol

Heavy alcohol consumption over many years is the primary cause of chronic pancreatitis. For acute pancreatitis, the relationship with alcohol is dose-dependent—the risk increases with the amount consumed. However, there is significant individual variation; some heavy drinkers never develop pancreatitis while others develop it with moderate consumption. Smoking significantly amplifies the damaging effects of alcohol on the pancreas.

Other Important Causes

• High triglycerides (hypertriglyceridemia) - Triglyceride levels above 1000 mg/dL significantly increase risk
• Medications - Including certain antibiotics, diuretics, and immunosuppressants
• Endoscopic procedures (post-ERCP) - Pancreatitis occurs in 3-5% of ERCP procedures
• Infections - Viral infections (mumps, coxsackie virus) and parasitic infections
• Abdominal trauma - Blunt or penetrating injury to the abdomen
• Autoimmune pancreatitis - The immune system attacks the pancreas
• Genetic factors - Hereditary pancreatitis due to gene mutations
• Hypercalcemia - High calcium levels in the blood
• Pancreatic tumors - Can cause obstruction of pancreatic ducts

How Is Pancreatitis Diagnosed?

Pancreatitis is diagnosed based on a combination of symptoms (severe abdominal pain), laboratory tests (elevated lipase or amylase levels 3 times above normal), and imaging studies (CT scan or ultrasound). A diagnosis requires at least two of these three criteria. Ultrasound is particularly important for detecting gallstones as the underlying cause.

When you arrive at a healthcare facility with symptoms suggestive of pancreatitis, the diagnostic process begins with a thorough medical history and physical examination. Your doctor will ask about the location, quality, and timing of your pain, any recent alcohol consumption, history of gallstones, medications you take, and any previous episodes of similar pain.

During the physical examination, your doctor will feel your abdomen for tenderness, distension, and any masses. The abdomen is often very tender in pancreatitis, and patients may guard their belly when touched. Your vital signs (heart rate, blood pressure, temperature) will be checked, as abnormalities can indicate the severity of the condition.

Laboratory Tests

Blood tests are essential for diagnosing pancreatitis and assessing its severity. The most important tests measure pancreatic enzymes:

• Serum lipase - The preferred test; levels more than 3 times the upper limit of normal strongly suggest pancreatitis. Lipase remains elevated longer than amylase (up to 14 days).
• Serum amylase - Rises within hours of symptom onset but returns to normal within 3-5 days. Less specific than lipase as it can be elevated in other conditions.

Additional blood tests help assess severity and identify complications:

• Complete blood count - May show elevated white blood cells indicating inflammation or infection
• Liver function tests - Elevated levels suggest gallstones may be the cause
• Triglycerides - To identify hypertriglyceridemia as a cause
• Calcium - Low calcium can occur in severe pancreatitis
• Blood glucose - May be elevated due to pancreatic dysfunction
• Kidney function tests - To assess for organ involvement

Imaging Studies

Imaging plays a crucial role in confirming the diagnosis, identifying the cause, and detecting complications:

Abdominal Ultrasound

Usually the first imaging test performed, ultrasound is excellent for detecting gallstones, which are present in about 40% of pancreatitis cases. It can also show dilation of the bile duct and some pancreatic changes, though visualization of the pancreas may be limited by intestinal gas.

Computed Tomography (CT) Scan

CT with contrast is the gold standard for assessing the severity of pancreatitis and detecting complications. It can show pancreatic inflammation, necrosis (dead tissue), fluid collections, and pseudocysts. CT is typically performed 72 hours or more after symptom onset to accurately assess the extent of damage.

Magnetic Resonance Cholangiopancreatography (MRCP)

A specialized MRI that provides detailed images of the pancreatic and bile ducts without requiring invasive procedures. Particularly useful for detecting small gallstones, bile duct abnormalities, and chronic pancreatitis changes.

Endoscopic Ultrasound (EUS)

Combines endoscopy with ultrasound to provide detailed images of the pancreas from inside the stomach. Useful for detecting small tumors, stones in the bile duct, and early chronic pancreatitis changes that may not be visible on other imaging.

How Is Pancreatitis Treated?

Treatment focuses on supportive care including intravenous fluids, pain control, and nutritional support. Mild acute pancreatitis usually resolves in 3-5 days with hospital care. The underlying cause must be addressed—gallstones require surgery, and alcohol must be completely avoided. Chronic pancreatitis requires long-term management including enzyme supplements and lifestyle modifications.

The treatment of pancreatitis depends on whether the condition is acute or chronic, the severity of the attack, and the underlying cause. In all cases, the immediate goals are to relieve symptoms, support the body's recovery, and prevent complications. Long-term management focuses on addressing the root cause and preventing recurrence.

Treatment of Acute Pancreatitis

Most cases of acute pancreatitis require hospitalization, at least initially. The cornerstone of treatment is supportive care while the pancreas heals:

Intravenous Fluids (IV Fluids)

Aggressive fluid resuscitation is critical in the first 24-48 hours. Pancreatitis causes significant fluid shifts and patients often become severely dehydrated. Lactated Ringer's solution is typically preferred. Adequate hydration improves blood flow to the pancreas and reduces the risk of complications.

Pain Management

Pancreatitis pain can be severe and requires appropriate analgesia. Mild to moderate pain may be managed with non-steroidal anti-inflammatory drugs (NSAIDs), while severe pain often requires opioid medications. Patient-controlled analgesia (PCA) may be used in hospital settings.

Nutritional Support

Historically, patients were kept NPO (nothing by mouth) to "rest" the pancreas. However, current guidelines recommend early enteral feeding (within 24-72 hours) for most patients, as this supports gut function and may reduce infection risk. For mild pancreatitis, patients can often start eating a low-fat diet once pain improves and appetite returns.

Treatment of Underlying Cause

For gallstone pancreatitis, cholecystectomy (surgical removal of the gallbladder) is recommended during the same hospitalization for mild cases, or within 2-4 weeks for severe cases. If a stone is stuck in the bile duct, endoscopic removal (ERCP) may be needed urgently. For alcohol-related pancreatitis, cessation of alcohol is essential.

Treatment of Severe Acute Pancreatitis

Approximately 20% of acute pancreatitis cases are severe, requiring intensive care unit (ICU) admission. These patients may develop:

• Organ failure - Requiring respiratory support, dialysis, or blood pressure medications
• Pancreatic necrosis - May require interventional drainage or surgery if infected
• Pseudocysts - Fluid collections that may need drainage if symptomatic

Management of severe pancreatitis is complex and requires a multidisciplinary team including gastroenterologists, surgeons, intensivists, and interventional radiologists.

Treatment of Chronic Pancreatitis

Chronic pancreatitis cannot be cured, as the damage to the pancreas is irreversible. Treatment focuses on managing symptoms, preventing further damage, and treating complications:

Pain Management

Chronic pain is the most challenging aspect of treatment. Options include regular analgesics, nerve block procedures, and in some cases, surgery to decompress the pancreatic duct or remove parts of the pancreas.

Pancreatic Enzyme Replacement

As the pancreas loses its ability to produce digestive enzymes, patients develop malabsorption. Pancreatic enzyme supplements (containing lipase, protease, and amylase) are taken with each meal to aid digestion and improve nutrient absorption. The dose is adjusted based on symptoms and stool characteristics.

Nutritional Support

Patients should follow a low-fat diet (less than 20 grams per day for severe cases) and eat smaller, more frequent meals. Fat-soluble vitamin supplements (A, D, E, K) may be needed. Alcohol must be completely eliminated.

Diabetes Management

Many patients with chronic pancreatitis eventually develop diabetes due to destruction of insulin-producing cells. This requires monitoring blood sugar levels and treatment with insulin or other diabetes medications.

What Can I Do to Prevent Pancreatitis?

Prevention focuses on addressing modifiable risk factors: limit or avoid alcohol, don't smoke, maintain a healthy weight, eat a low-fat diet, manage triglyceride levels, and treat gallstones promptly. If you've had pancreatitis, complete alcohol abstinence is critical to prevent recurrence and progression to chronic disease.

While not all cases of pancreatitis can be prevented, there are significant steps you can take to reduce your risk, especially if you have risk factors or have already experienced an episode of pancreatitis:

Alcohol Moderation or Abstinence

For the general population, moderate alcohol consumption (up to one drink per day for women, two for men) is unlikely to cause pancreatitis. However, heavy drinking significantly increases risk. If you have had pancreatitis, even once, complete abstinence from alcohol is strongly recommended. Continuing to drink after an episode dramatically increases the risk of recurrence and progression to chronic pancreatitis.

Stop Smoking

Smoking is an independent risk factor for pancreatitis and significantly amplifies the harmful effects of alcohol. It also accelerates the progression of chronic pancreatitis. Smoking cessation is one of the most important steps you can take for your pancreatic health.

Maintain a Healthy Diet and Weight

A diet high in fruits, vegetables, whole grains, and lean proteins while low in saturated fat and processed foods supports pancreatic health. Obesity increases the risk of gallstones, which are a major cause of pancreatitis. Gradual weight loss (if needed) and maintaining a healthy weight reduce this risk.

Manage Triglycerides

Very high triglyceride levels (above 1000 mg/dL) can directly cause pancreatitis. If you have high triglycerides, work with your doctor to lower them through diet, exercise, and medications if needed. Avoiding alcohol and refined carbohydrates is particularly important for triglyceride control.

Treat Gallstones

If you have symptomatic gallstones (causing biliary colic or other symptoms), discuss treatment options with your doctor. Elective cholecystectomy (gallbladder removal) can prevent gallstone pancreatitis. If you've already had gallstone pancreatitis, surgery is typically recommended to prevent recurrence.

What Complications Can Pancreatitis Cause?

Acute pancreatitis can lead to serious complications including pancreatic necrosis (death of tissue), infection, pseudocysts, organ failure, and rarely death. Chronic pancreatitis causes progressive loss of pancreatic function leading to malnutrition, diabetes mellitus, and increased risk of pancreatic cancer.

Most cases of mild acute pancreatitis resolve without complications. However, severe pancreatitis can lead to life-threatening complications that require intensive medical care:

Complications of Acute Pancreatitis

Pancreatic Necrosis

In severe pancreatitis, portions of the pancreas may die due to lack of blood supply and direct enzyme damage. Necrosis occurs in about 20% of acute pancreatitis cases and significantly increases mortality risk, especially if the necrotic tissue becomes infected.

Infection (Infected Pancreatic Necrosis)

Necrotic pancreatic tissue can become infected with bacteria from the gut. This is a serious complication requiring antibiotics and often surgical or interventional drainage. It typically occurs 2-4 weeks after the initial episode.

Pseudocysts

Fluid collections surrounded by a wall of fibrous tissue may form around the pancreas. Small pseudocysts often resolve on their own, but larger ones may cause pain, become infected, or compress surrounding structures, requiring drainage.

Organ Failure

Severe systemic inflammation can affect multiple organ systems:

• Respiratory failure (fluid in the lungs, acute respiratory distress syndrome)
• Kidney failure (requiring dialysis)
• Cardiovascular shock (dangerously low blood pressure)

Complications of Chronic Pancreatitis

Exocrine Insufficiency

As the pancreas loses its ability to produce digestive enzymes, malabsorption of fats and fat-soluble vitamins occurs. This leads to steatorrhea (oily stools), weight loss, and nutritional deficiencies.

Diabetes Mellitus

Destruction of the insulin-producing beta cells leads to "pancreatogenic" diabetes in 40-80% of chronic pancreatitis patients. This type of diabetes can be difficult to manage because glucagon production is also impaired, increasing the risk of hypoglycemia.

Pancreatic Cancer

Chronic pancreatitis is a significant risk factor for pancreatic cancer, with risk increasing over time. Regular monitoring and discussion of cancer screening with your healthcare provider is important.

How Do I Live with Chronic Pancreatitis?

Living with chronic pancreatitis requires lifelong management including taking enzyme supplements with every meal, following a low-fat diet, complete alcohol abstinence, regular medical follow-up, and managing pain and complications like diabetes. Support groups and mental health resources can help cope with the challenges of this chronic condition.

Chronic pancreatitis is a challenging condition that requires significant lifestyle adjustments. However, with proper management, many people with chronic pancreatitis can maintain a good quality of life:

Dietary Management

Following a low-fat diet is essential—aim for less than 20-30 grams of fat per day. Eat smaller, more frequent meals rather than large ones. Avoid fried foods, fatty meats, full-fat dairy, and processed foods. Take your prescribed pancreatic enzyme supplements with every meal and snack that contains fat or protein.

Alcohol and Smoking Cessation

Complete and permanent abstinence from alcohol is critical. Even small amounts can trigger pain and accelerate pancreatic damage. Smoking cessation is equally important. Seek professional help and support groups if needed—quitting is difficult but essential for your health.

Pain Management

Work with your healthcare team to develop an effective pain management plan. This may include medications, nerve blocks, or in some cases, surgical procedures. Avoid relying solely on opioids due to risks of dependence and tolerance.

Regular Medical Follow-Up

Schedule regular appointments with your gastroenterologist. Monitor for complications including diabetes, malnutrition, and pancreatic cancer. Keep up with recommended blood tests and imaging studies.

Emotional Support

Living with chronic pain and dietary restrictions can be emotionally challenging. Consider joining a support group, speaking with a counselor, or connecting with others who understand your experience. Depression and anxiety are common in chronic pancreatitis and should be addressed as part of your overall care.