Acute pancreatitis: symptoms, causes, treatment and recovery

The main symptom is pain in the tummy, with the NHS also listing a high temperature and nausea and vomiting. The pain may start suddenly and not go away, be severe, sharp or knife-like, affect the upper tummy between the ribs, one side or the whole tummy, spread to the sides and back, feel worse after eating, moving or lying down, and feel better when leaning forward or bringing the knees to the chest. Symptoms can resemble other conditions such as appendicitis or a stomach ulcer.

The NHS says to ask for an urgent GP appointment or call NHS 111 for sudden, severe tummy pain that does not go away or keeps coming back, or with a high temperature or shivering. It says to call 999 or go to A&E if the pain is spreading to the back, bloating does not go away or keeps coming back, you have a fast heartbeat or difficulty breathing, or the skin around the belly button, waist or upper outer thigh looks blue or bruised. Do not drive to A&E.

The pancreas is an organ in the middle of the tummy that helps digest food and makes hormones such as insulin. In acute pancreatitis it becomes suddenly swollen and painful. The NHS distinguishes it from chronic pancreatitis, a long-term condition in which the pancreas has become permanently damaged. Repeated acute attacks can lead to chronic pancreatitis.

The most common causes are gallstones, which can block the opening of the pancreas, and drinking a lot of alcohol. Less common causes listed by the NHS include injury to the pancreas, for example during surgery; medicines, including certain steroids, heart and epilepsy medicines; and conditions such as lupus, mumps, pancreatic cancer or high blood calcium. NICE says that if gallstones and alcohol have been excluded, other causes are investigated, such as metabolic causes (high calcium or fats in the blood), prescription drugs, microlithiasis, hereditary causes, autoimmune pancreatitis, tumours and anatomical anomalies.

The NHS says acute pancreatitis is usually diagnosed using blood tests and sometimes a CT scan, and that you will be monitored in hospital to see how serious your condition is and whether it is causing any other problems, such as an infection. A GP who thinks you have it will refer you to hospital for tests straight away.

NICE says people with acute pancreatitis usually present with sudden-onset abdominal pain, often with nausea and vomiting, and that there may be a history of gallstones or excessive alcohol intake. Typical signs include tenderness in the upper tummy, fever and a fast heartbeat. The diagnosis is confirmed by testing blood lipase or amylase levels, which are usually raised, though raised levels may occur in other conditions. If raised levels are not found, an abdominal CT may confirm pancreatic inflammation.

NICE also says not to assume the cause is alcohol just because a person drinks alcohol. If gallstones and alcohol have been excluded, other possible causes are investigated, such as high calcium or fats in the blood, prescription drugs, microlithiasis, hereditary causes, autoimmune pancreatitis, tumours and anatomical anomalies.

The NHS says hospital treatment may include fluids and nutrients given through a tube into a vein, painkillers, and antibiotics if you have an infection. You may also need treatment for what is causing the pancreatitis, such as surgery for gallstones or support to stop drinking alcohol.

NICE guidance for clinicians says not to offer antibiotics routinely to prevent infection in people with acute pancreatitis. It recommends enteral nutrition (feeding into the gut) for anyone with severe or moderately severe acute pancreatitis, started within 72 hours, with parenteral nutrition (into a vein) only if enteral nutrition has failed or is not possible.

If complications develop such as infected necrosis, NICE says to seek advice from a specialist pancreatic centre and to discuss whether to move the person there for treatment. It recommends an endoscopic approach for infected pancreatic necrosis when anatomically possible.

NICE says people with acute pancreatitis should not be made nil-by-mouth or have food withheld unless there is a clear reason for this, for example vomiting. It recommends starting enteral nutrition within 72 hours for those with severe or moderately severe disease and aiming to meet their nutritional requirements as soon as possible.

For the longer term, the NHS suggests eating a healthy, low-fat diet and drinking less alcohol or none at all to help stop acute pancreatitis coming back. NICE says that people with pancreatitis caused by alcohol should be advised to stop drinking alcohol, and that people with recurrent acute pancreatitis that is not alcohol-related should be advised that alcohol might make it worse.

The NHS says most people with acute pancreatitis start to get better within a week and can leave hospital in 5 to 10 days, and that most recover fully. If you have severe pancreatitis or it is causing other problems, you may need to stay in hospital for longer.

NICE says clinicians should explain to people with severe acute pancreatitis that a hospital stay lasting several months is relatively common, including time in critical care, and that time to recover may take at least 3 times as long as the hospital stay. It also says that people who have started to recover may have a relapse and that approximately 15% to 20% of adults with severe acute pancreatitis die in hospital.

The NHS says it is possible to get acute pancreatitis again after one episode. It suggests drinking less alcohol or none at all, stopping smoking and eating a healthy, low-fat diet. When gallstones are the cause, treating them is part of preventing recurrence.

Acute pancreatitis is treated through A&E and hospital admission, because monitoring and fluids are essential from the start. The NHS says to call 999 or go to A&E for the severe symptoms listed above, and not to drive to A&E.

Follow-up, such as gallbladder surgery or support to stop drinking alcohol, may be arranged on the NHS or privately. Ask how follow-up will be coordinated with the admitting team. NICE says that people with pancreatitis should be given information on where to find support, such as national and local support groups and regional pancreatitis networks.