Chronic pancreatitis: symptoms, causes, treatment and outlook

The NHS says the main symptom is pain in the tummy, which may be in the upper part just below the ribs, on one side or across the whole tummy, constant or coming and going, severe or like a dull ache, better when sitting down and leaning forward, or worse after eating. NHS inform says the pain can travel along the back and be described as burning or shooting.

Other symptoms can include the following, and the NHS notes that symptoms can be similar to other conditions such as irritable bowel syndrome or gallstones.

• Feeling or being sick.

• Diarrhoea, and very smelly poo that floats and is difficult to flush away.

• Feeling bloated or passing a lot of wind.

• Feeling thirsty or needing to pee a lot, which may point to diabetes.

• Losing weight without trying to.

• NHS inform adds jaundice (yellowing of the skin and eyes) and persistent vomiting as reasons to see a GP.

The NHS says to see a GP if you think you might have chronic pancreatitis, and to ask for an urgent GP appointment or get help from NHS 111 if you get sudden, severe pain in your tummy, which could be a sign of acute pancreatitis or another condition needing hospital treatment as soon as possible.

NHS inform says to always visit your GP if you have severe pain, as it is a warning sign that something is wrong.

There is currently no cure. The NHS says treatment can help manage symptoms and related problems, with support from your GP, specialists, nurses and dietitians. Treatments may include painkillers, medicines that help the body absorb nutrients from food, medicines for diabetes such as insulin, and surgery to remove cysts or unblock blockages in the pancreas or bile ducts. Sometimes the cause is treated: steroid medicine can help if the immune system is attacking the pancreas.

NHS inform says that in most cases there is no specific treatment to reduce the inflammation and repair damage, so treatment focuses on lifestyle changes and medication to relieve pain. Surgery is sometimes needed for severe pain that does not respond to painkillers, and the pain can be difficult to treat and seriously affect quality of life.

NICE Clinical Knowledge Summaries lists what management of confirmed chronic pancreatitis should include: advice on sources of information and support, management of risk factors including alcohol and smoking, advice on pain management, and management of malabsorption or malnutrition, including pancreatic enzyme replacement therapy, fat-soluble vitamin supplements and monitoring of nutritional status, plus screening for diabetes and osteoporosis. It advises considering specialist referral for uncontrolled or recurrent pain or an unexpected change in symptoms, or if cancer is suspected.

The NHS says the most common cause is drinking alcohol. Drinking too much alcohol can cause the pancreas to become inflamed for a short time, and if you keep drinking and keep getting acute pancreatitis, the pancreas can eventually become permanently scarred. NHS inform says only a minority of people who drink regularly develop the condition.

Other causes the NHS lists include smoking, genes (including the gene that causes cystic fibrosis, the most common cause in children), the immune system mistakenly attacking the pancreas, the pancreas not developing properly at birth, and some medicines, including some antibiotics and diabetes medicines. NHS inform says that in as many as 3 out of 10 people the cause cannot be identified.

NICE CKS says alcohol is the major cause, responsible for up to 70 to 80% of cases, and that other risk factors include smoking, raised triglycerides or calcium, autoimmune disease, obstruction, genetic causes and drugs.

The pancreas is an organ in the middle of the tummy that helps with digestion and makes hormones such as insulin. In chronic pancreatitis it becomes permanently damaged from inflammation, which NHS inform says is different from acute pancreatitis, where inflammation is short-term.

Over years the damage can reduce the pancreas's ability to produce digestive juices and insulin, which is why the condition affects both digestion and blood sugar. The NHS says the damage usually gets worse over time and it is not possible to reverse it, but stopping alcohol and smoking can slow it down.

The NHS says there is no single test and a doctor may need to rule out other causes first. A GP may feel your tummy, check whether your skin and eyes look yellow, weigh you, arrange blood tests or tests on a poo sample, and ask whether close relatives have had pancreatitis. They may refer you for scans such as CT or ultrasound, or a gastroscopy.

NHS inform says chronic pancreatitis can usually only be diagnosed by scans of the pancreas, which may include ultrasound, CT, endoscopic ultrasonography and MRCP, and that a biopsy may be recommended to rule out pancreatic cancer when symptoms such as jaundice and weight loss are present.

The NHS says things you can do to help stop the damage getting worse and reduce the risk of other problems are to eat a healthy, balanced diet, which helps you get the nutrients you need, not to drink alcohol, because it can cause more damage even if the condition was not caused by alcohol, and not to smoke, as giving up can help slow the damage. The NHS Better Health service offers free tools and support to help you eat healthily, quit smoking and drink less.

Because the pancreas makes the enzymes that digest food, NICE CKS notes that malabsorption and malnutrition are managed with pancreatic enzyme replacement and vitamin supplements, with nutritional status monitored and a dietitian referral considered where there is malnutrition or malabsorption. The sources reviewed do not give a specific fat allowance or diet plan, so ask your dietitian or specialist team for advice that fits you.

The NHS lists difficulty absorbing nutrients, which can cause weight loss and weakened bones (osteoporosis), type 3c diabetes, cysts around the pancreas that can become infected, bleed or press on nearby organs, and blockages of the pancreas or bile ducts that can cause pain or gallbladder inflammation. People with chronic pancreatitis also have a higher risk of pancreatic cancer.

Regular check-ups, tests and scans are used to look for problems such as diabetes or weakened bones.

The NHS suggests eating a healthy, balanced diet to get the nutrients you need, not drinking alcohol (even if the condition was not caused by alcohol) and not smoking. It describes chronic pancreatitis as a serious condition that can have a big impact on life and can affect how long you live, although most people live with it for many years.

NHS inform notes that living with chronic pain can cause mental as well as physical strain, and it is important to speak to your GP if you are experiencing stress, anxiety or depression. Guts UK and Pain Concern are named by the NHS as national charities offering support.

On the NHS your GP arranges initial tests, with referral to a gastroenterologist or pancreatic specialist for scans, pain management and nutrition. Dietitian support is part of care.

Private gastroenterology can offer faster scans and endoscopic ultrasound. Chronic pain and nutrition are long-term issues, so it helps to make sure private and NHS teams share results, and to ask who will coordinate ongoing monitoring for diabetes and bone health.