Pancreatitis is the medical term for pancreas inflammation, which can cause severe abdominal pain, nausea, and vomiting. Pancreatitis can be acute (developing suddenly and lasting a short time) or chronic (developing slowly and worsening over time).
Men are more likely to develop pancreatitis than women. Acute pancreatitis commonly affects people in their 30s, while chronic pancreatitis is commonly diagnosed among people in their 50s. Younger people with chronic pancreatitis often have inherited the condition.
When people are admitted to the hospital with abdominal pain, acute pancreatitis is the most common diagnosis. At least 250,000 Americans receive inpatient care for pancreatitis annually.
Treatments are available to manage pancreatitis. For acute pancreatitis, it’s important to identify and treat its underlying cause to prevent a recurrence. For patients with chronic pancreatitis, however, the goal is to control the inflammation to minimize symptoms and complications. It isn’t possible to reverse damage caused by chronic pancreatitis, but it is possible to slow its progress with treatments.
What is pancreatitis?
Pancreatitis, or inflammation of the pancreas, is a condition that causes intense abdominal pain. Though there are numerous potential causes of pancreatitis, the two most common ones are gallstones and alcohol misuse.
There are several types of pancreatitis, all of which cause abdominal pain:
- Acute pancreatitis, which comes on suddenly and has not happened before
- Chronic pancreatitis, when the condition recurs and worsens over time
- Hereditary pancreatitis, an inherited form
- Autoimmune pancreatitis, which occurs when the body's immune system mistakenly attacks healthy tissue/cells in the pancreas
- Alcoholic pancreatitis, which occurs when alcohol misuse leads to the condition
Your pancreas is located in the abdomen, between the spine and stomach. It is responsible for secreting hormones, such as insulin and glucagon, and enzymes, including amylase and lipase, all of which are essential for digestion in the small intestine.
In someone with pancreatitis, these enzymes become active earlier than they should, within the pancreas rather than waiting until they are secreted, or released, into the small intestine. These mistakenly released enzymes then begin to digest the pancreas, causing inflammation, bleeding, pain, and organ damage, including the formation of scar tissue (called fibrosis).
In people with alcohol-induced pancreatitis, increased secretions, thicker than the usual type, cause blockages in small pancreatic ducts, preventing the enzymes from leaving the pancreas.
When pancreatitis is chronic, the inflammation and organ damage limits the organ’s ability to produce enough enzymes for digestion. As a result, nutrients aren’t absorbed from food in the small intestine. These nutrients leave the body via the stool, which appears greasy or oily, with an unusual color and a foul odor. People may experience weight loss or nutritional deficiencies. In some cases, pancreatitis can cause diabetes by affecting the amount of insulin the body produces.
Occasionally, pancreatic fluid leaks out of the pancreas, forming what’s called a “pseudocyst”— a fluid-filled structure—outside the pancreas.
During severe pancreatitis, people may experience intense abdominal pain, shortness of breath, and/or a fast heartbeat. People with these symptoms may have a serious infection, or a gallstone may be blocking a bile or pancreatic duct. Because a serious infection may be life-threatening, it’s crucial to seek medical attention quickly.
What causes pancreatitis?
The two main causes of pancreatitis are gallstones and alcohol misuse.
Other causes of pancreatitis include:
- A family history of pancreatitis or high triglyceride levels
- The genetic mutations PRSS1, R122H, R122C, N29I, A16V, CTRC, SPINK1, CFTR, CASR, CPA1, PRSS2, and CLDN2
- A procedure called an endoscopic retrograde cholangiopancreatography, which is used to diagnose or treat the pancreatic ducts or bile ducts, can occasionally cause the condition
- Cystic fibrosis
- Reye’s syndrome
- Coxsackie B virus
- High triglyceride levels
- An overactive parathyroid gland
- Crohn’s disease
- Kawasaki disease
- Kidney failure
- An organ transplant
- Trauma to the pancreas
- Pancreas divisum, a birth defect
- Pancreatic cancer
Additionally, certain medications may lead to pancreatitis, including:
- Sulfonamides, a class of antibiotics
- Thiazides, a type of diuretics
- Azathioprine, which may be prescribed after a kidney transplant
- Some anti-seizure medications
- Certain chemotherapy drugs
- Tamoxifen, a breast cancer drug
What are the symptoms of pancreatitis?
Severe abdominal pain is the hallmark symptom of pancreatitis, although some people experience mild pain—or none at all. Over time, people with chronic pancreatitis may no longer experience pain, which is a signal that the organ no longer functions properly.
Most people with pancreatitis may experience:
- Sudden, severe upper abdominal pain that doesn’t resolve for days
- Pain that encircles the torso, resulting in back pain
- Pain that may be relieved by leaning forward and that worsens when lying down
- Pain that becomes more intense within 15 to 30 minutes after meals
- Pain that intensifies after consuming alcohol
- Nausea and/or vomiting
- Indigestion or bloating
- A tender, distended abdomen
- A faster-than-usual heartbeat
- Weight loss
- Shortness of breath
- Stool that appears fatty, oily, foul-smelling, pale, clay-colored, or orange
How is pancreatitis diagnosed?
A diagnosis of pancreatitis typically is made after a doctor reviews your medical history, performs a physical exam, and evaluates diagnostic tests.
Let your doctor know details about the symptoms you are experiencing: What does your abdominal pain feel like, and how long has it been happening? Are you having other gastrointestinal (GI) symptoms, such as nausea or diarrhea? Have you been diagnosed with gallstones?
Also, it’s important to be honest with your doctor about how much alcohol you consume. Tell your doctor if you’ve had pancreatitis or if other family members have the condition.
During a physical exam, your doctor will gently touch your abdomen to see if you have pain in certain areas, or if you’re experiencing bloating or swelling. They will look for other signs of pancreatitis, such as a rapid heartbeat or breathing difficulties.
You may be offered one or more of the following diagnostic tests to determine if you have pancreatitis and to rule out other conditions:
- Blood tests, which show whether or not you have normal levels of the digestive enzymes lipase and amylase. Your blood sugar and cholesterol levels will also be checked. Blood tests can also detect an infection in the pancreas, gallbladder, bile ducts, or pancreatic ducts, and these same tests may also be used to diagnose pancreatic cancer.
- Stool sample test to determine whether or not your GI system is properly absorbing fat and nutrients from food.
- Urine test to check for the amylase enzyme
- Imaging tests of the abdomen, including ultrasounds, computed tomography (CT) scans, and magnetic resonance cholangiopancreatography (MRCP), show the pancreas, bile ducts, and surrounding structures. Images may show inflammation, gallstones, pancreatic cancer, or other conditions.
- Endoscopic ultrasound is an ultrasound device attached to the end of a long, thin tube inserted through the mouth, down the throat, through the stomach, and to the small intestine. It uses sound waves to create images of the pancreas, pancreatic ducts, and bile ducts.
- Pancreas function test, in which doctors measure the pancreas’s response to the hormone secretin, which is produced by the small intestine.
How is pancreatitis treated?
There are several treatments that may be helpful for pancreatitis, including:
Supportive care. Treatments for those hospitalized with pancreatitis include:
- Intravenous (IV) fluids
- Soft, low-fat foods
- A feeding tube, If the patient is unable to eat
Medications. Patients with pancreatitis may be given the following medications:
- Pain relievers, such as gabapentin or nortriptyline, to reduce or eliminate abdominal pain.
- Antibiotics for a bacterial infection
- Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants, to help manage chronic pain
- Corticosteroids, which may be useful when a patient has autoimmune pancreatitis
Surgery. Some patients with pancreatitis may need one or more of the following procedures:
- Lithotripsy, which uses shockwaves to break large gallstones into smaller pieces
- Endoscopic retrograde cholangiopancreatography, which can unblock a clogged duct if scar tissue or a gallstone is present
- Gallbladder removal
- Placing a catheter in a pseudocyst to drain the fluid
- Removal of dead pancreatic tissue
Lifestyle changes. Lifestyle modifications can be crucial in the management of chronic pancreatitis. Patients may be asked to:
- Abstain from using alcohol
- Stop smoking
- Eat low-fat meals
- Eat four to six small meals per day, which may reduce the release of pancreatic enzymes
- Properly manage diabetes, if applicable
What is the outlook for people with pancreatitis?
Most people with acute pancreatitis typically recover within a short time frame without complications. However, if left untreated, it is possible to die from severe acute pancreatitis.
People with chronic pancreatitis may experience changes to their pancreas over time, such as scarring of pancreatic tissue and decreased functioning of the pancreas. They are also at increased risk of pancreatic cancer.
What makes Yale unique in its treatment of pancreatitis?
“The Yale Center for Pancreatitis is a regional center for expertise in the management of pancreatitis,” says Priya Jamidar, MBChB, the director of the Yale Endoscopy Program and an expert in pancreatic disease treatment. “Yale offers a team-based approach with physicians, nurse practitioners, and expert nurses to provide state-of-the-art care and cutting-edge and innovative procedures for the diagnosis and management of pancreatitis. In addition, there are ongoing research studies on both acute and chronic pancreatitis that help advance our understanding of the mechanisms underlying this disease and ways to improve treatment.”