Pancreatitis refers to inflammation of the pancreas, a long flat organ tucked behind your stomach. It is a medical condition that causes belly pain, vomiting, and sometimes even life-threatening symptoms. In the United States, around 50,000 people are admitted to the hospital for symptoms of pancreatitis every year.
Although most people have temporary, less severe pancreatitis that never comes back, some people experience more extreme complications and repeated episodes. The symptoms of pancreatitis and their treatment vary based on whether your case is acute or chronic.
Types of Pancreatitis
Clinicians distinguish acute pancreatitis, which comes on suddenly, from chronic pancreatitis, which happens over a long period of time.
Acute pancreatitis refers to a sudden attack of inflammation of the pancreas that usually never comes back. Acute pancreatitis causes symptoms like upper abdominal pain that seem to come out of nowhere. However, symptoms generally go away shortly after they are treated.
Sometimes healthcare providers also talk about acute pancreatitis that is severe versus acute pancreatitis that is milder. The severe form happens in about 10% of people who get symptoms of acute pancreatitis.
People with chronic pancreatitis have long-term inflammation, scarring, and damage to the pancreas. Someone who has had repeated bouts of acute pancreatitis might eventually develop chronic pancreatitis, but it sometimes happens in people who haven’t had any symptoms.
Who Treats Pancreatitis?
Acute cases of pancreatitis can be treated by a general healthcare provider, such as a primary care provider or an emergency medicine physician. Chronic cases are usually treated by a gastroenterologist, a doctor who specializes in the digestive system.
You can roughly organize symptoms from pancreatitis according to their underlying cause.
Symptoms From Pancreas Inflammation
Pain in the abdomen is the most important and common symptom that occurs with pancreatitis. Often it is felt in the upper abdominal area and spreads to the back. This pain might be more severe but more temporary in acute pancreatitis. In contrast, someone with chronic pancreatitis might have less severe abdominal pain that doesn’t really go away.
Nausea and vomiting are other common symptoms, especially in acute pancreatitis. Other symptoms like racing heartbeat or fever might also occur in acute cases.
Symptoms From Complications
In people with severe pancreatitis, life-threatening symptoms can occur such as kidney failure. Another example is pancreatitis necrosis—death of pancreatic tissue—which can lead to sepsis. Sepsis is an overwhelming response to infection that can lead to very low blood pressure, organ damage, and even death if not adequately treated.
Symptoms From Impaired Pancreas Function
The pancreas normally does the job of delivering hormones like insulin and digestive enzymes to the small intestine. In some people with pancreatitis, especially chronic pancreatitis, the damage to the pancreas is so severe that it can’t do this well anymore.
This can cause symptoms like greasy stool, diarrhea, and even a type of diabetes called pancreatogenic diabetes, or type 3c diabetes.
What Causes Pancreatitis?
When digestive enzymes from the pancreas get abnormally released, it can cause inflammation and damage to the pancreas. In acute pancreatitis, this inflammation gets triggered suddenly, and it is often reversible. In chronic pancreatitis, the inflammation may be ongoing but may not be as intense.
The leading cause of pancreatitis in most parts of the world is gallstone disease. Gallstones are small, hard deposits, usually made of cholesterol or bilirubin, that develop in your gallbladder (the organ beneath your liver that releases bile into your small intestine). Gallstones can block the ducts leading from the pancreas to the small intestine, and the pancreatic enzymes can start to damage the pancreas itself. Alcohol is another one of the most common causes of acute pancreatitis.
Another relatively common cause is hypertriglyceridemia, having elevated levels of certain fats in your blood.
Other less common causes of pancreatitis are:
- Side effects from certain drugs
- Abdominal injury, such as blunt force trauma
- Hypercalcemia (elevated calcium in the blood)
- Rare anatomical variation in the pancreas
- Pancreatic tumor (this is rare, and even less common in people under 55 years of age)
- Certain viral infections such as mumps or pneumonia (this is very rare and usually only causes acute cases)
Smoking and heavy alcohol use are two of the biggest risk factors for pancreatitis.
Some people may also have specific genes that increase their risk. Higher incidences are associated with the following genes:
- Cationic trypsinogen gene (PRSS1)
- Pancreatic secretory trypsin inhibitor gene (SPINK1)
- Cystic fibrosis transmembrane conductance regulator gene (CFTR)
- Chymotrypsinogen gene (CTRC)
- Carboxy peptidase A1 gene (CPA1)
How Is Pancreatitis Diagnosed?
Many different medical conditions which require different treatments can cause sudden abdominal pain, like appendicitis, gallbladder disease, diverticulitis, or even rupture of a very large blood vessel called the aorta. It’s important for your healthcare provider to rule out these other potential causes while establishing the correct diagnosis.
Your medical history and exam are an important part of diagnosis. Usually, additional lab tests are also used to help diagnose pancreatitis. Some of these might include:
- Amylase blood test: This is a strong indicator of acute pancreatitis if elevated to three times the normal level (the normal range is 40 to 140 units per liter (U/L) or 0.38 to 1.42 microkat/L (µkat/L)).
- Lipase blood test: This test is used similarly to the amylase test; pancreatitis is indicated if elevated to three times the normal level (the normal range is 0 to 160 units per liter (U/L) or 0 to 2.67 microkat/L (µkat/L)).
- Bilirubin test: This is used with other blood tests to check for blockages in the bile ducts.
- Complete blood count and comprehensive metabolic panel: These give information on overall health status to ensure the treating healthcare team can help you maintain healthy glucose, calcium, and magnesium levels.
Other blood tests may be needed, especially if you have severe acute pancreatitis or if the underlying cause of the pancreatitis is unknown.
Amylase and lipase aren’t as helpful as they are for acute pancreatitis. If chronic pancreatitis is suspected, other blood tests or tests on your stool may show that the pancreas isn’t functioning well.
Getting a look at the pancreas is also often very helpful in making the diagnosis and ruling out other conditions. Imaging options may include:
- Computed tomography (CT) imaging
- Magnetic resonance imaging (MRI)
Many of these same tests and imaging tools can also be used to help diagnose chronic pancreatitis.
Treatments for Pancreatitis
Treatment can vary based on whether your pancreatitis is acute or chronic and whether you have complications or severe disease.
For acute pancreatitis, the goal is to provide pain relief and to help prevent or treat severe complications. For example, treatment may include:
- Breathing supplemental oxygen
- Receiving additional fluids through your veins
- Helping you eat again, or giving you food through a feeding tube if needed
- Taking non-steroidal anti-inflammatory drugs like Advil (ibuprofen) and/or stronger narcotic drugs like Vicodin (hydrocodone)
People with complications from acute severe pancreatitis may need additional treatments in an intensive care unit. For example, you might need a tube down your throat to help you breathe, dialysis for poor kidney function, or a medical procedure to drain fluid from part of the pancreas that has died.
Some people also need to address the underlying cause of acute pancreatitis (e.g., a procedure to remove a gallstone that is causing pancreatitis). For example, you might need endoscopic retrograde cholangiopancreatography (ERCP), which inserts a long flexible tube down your throat and into your gastrointestinal system to remove gallstones.
Pain management is a big part of treatment for chronic pancreatitis. Depending on the circumstances, this might involve:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Narcotic pain medications (only if necessary)
- Procedures to stop signals from nerves in the area (e.g., celiac plexus nerve block)
- Endoscopic procedures using a long tube passed down your throat, such as placing a stent in part of the pancreas’ ducts
- Surgical approaches, such as removing part or all of the pancreas
For people with chronic pancreatitis, smaller but more frequent and low-fat meals may also help reduce pain.
Treatments for Poor Pancreas Function
Some people with chronic pancreatitis need treatments for poor pancreas function. This also may happen to some people with more severe acute pancreatitis. For example, these people might need:
- Oral digestive enzymes
- Supplemental vitamins, such as vitamin A
- Insulin, for symptoms from diabetes
Diabetes from pancreatitis is managed similarly to other types of diabetes, with a goal of keeping the the amount of glucose in a person's blood ("blood sugar") from getting too high.
Drinking only moderately or abstaining from alcohol is one of the most important things you can do to help prevent pancreatitis. Quitting smoking will also decrease your future risk.
Reducing your risk of gallstones is also important, particularly if you’ve already had a bout of pancreatitis related to them. It may help you reduce your risk of gallstones and pancreatitis if you:
- Eat a diet high in fiber, like fruits, vegetables, and whole grains
- Lower your intake of sugar and refined carbohydrates, like in white bread
- Choose healthy fats, like olive oil, when possible
Dramatic weight loss also temporarily increases the risk of gallstones, so if you are trying to lose weight, slow and steady is better.
For some people with pancreatitis from gallstones, it may also make sense to prevent future episodes through surgical removal of the gallbladder, where gallstones form.
Some people with chronic pancreatitis or severe acute pancreatitis develop type 3c diabetes. Diabetes can happen because the pancreas is so damaged that it can no longer produce enough insulin. Without enough insulin, the amount of a glucose in a person's blood can get very high and cause lots of issues.
We don’t have good numbers on how common this is, but a 2016 review found that about 15% of people who have acute pancreatitis eventually developed diabetes. But this rate is considerably higher in people with chronic pancreatitis—perhaps closer to 40%.
The risk of future pancreatic cancer is also increased in people with chronic pancreatitis, as is the risk of osteoporosis.
Living With Pancreatitis
After a first attack of pancreatitis, about 20% of people will eventually have at least one more attack. About half of those people eventually develop chronic pancreatitis. This is more likely in people who are using alcohol heavily and don’t cut back and in smokers who don’t quit.
Living with chronic pain is a major challenge for many people with chronic pancreatitis. It may take a while to find the approach that works for you. You may find it helpful to work with a support group or personal therapist to find ways to cope.
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