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Health condition · Clinically reviewed

Pancreatitis, acute and chronic — causes, care and complications.

Acute pancreatitis is a severe emergency; chronic pancreatitis is a long-term condition. Modern imaging, EUS and specialist HPB care transform both.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BSG and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects current UK guidance on acute and chronic pancreatitis and specialist HPB care.

Key facts

Pancreatitis at a glance.

The essentials, in plain English — what it is, what causes it, how it is diagnosed, and how modern UK care manages both acute and chronic disease.

  • What it is

    Inflammation of the pancreas — either acute (a sudden severe attack) or chronic (long-standing damage and scarring).

  • Top causes

    Gallstones and alcohol are the two most common causes of pancreatitis in the UK.

  • Blood tests

    Serum amylase or lipase (typically three times the upper limit of normal) confirms acute pancreatitis.

  • Severity scoring

    Modified Glasgow and APACHE II scores stratify severity and guide critical-care escalation.

  • Chronic pattern

    Chronic pancreatitis leads to exocrine failure (steatorrhoea) and endocrine failure (type 3c diabetes).

  • Autoimmune type

    Autoimmune pancreatitis is a distinct, treatable entity — steroid-responsive and IgG4-linked.

Why this guide matters

Acute, chronic, autoimmune.

Pancreatitis is not one condition but three overlapping ones — each with a very different plan, and each shaped by the points below.

  • Acute attacks can be life-threatening

    Severe acute pancreatitis with organ failure needs critical care and specialist HPB input.

  • Chronic disease is manageable

    Enzyme replacement, insulin and lifestyle change transform quality of life in chronic pancreatitis.

  • Autoimmune disease is treatable

    Autoimmune pancreatitis responds dramatically to steroids — but must not be mistaken for cancer.

How the diagnosis is made

From first symptoms to a clear plan.

The steps a UK GP, acute team and HPB service will normally follow, in order — so you know what to expect and why.

  1. 01

    Recognising

    Symptom + risk history

    Pattern of pain, alcohol intake, gallstone history, medications and family history of pancreatic disease.

  2. 02

    Recognising

    Amylase / lipase

    A serum level three times the upper limit of normal, with typical pain, confirms acute pancreatitis.

  3. 03

    Recognising

    Ultrasound and CT

    Ultrasound to look for gallstones; contrast CT to assess pancreatic inflammation, necrosis and complications.

  4. 04

    Confirming

    MRCP

    Magnetic resonance cholangiopancreatography if a biliary cause or ductal abnormality is suspected.

  5. 05

    Confirming

    Endoscopic ultrasound

    EUS for chronic features, small stones, or subtle ductal and autoimmune changes.

  6. 06

    Managing

    Autoimmune serology

    IgG4 and autoimmune screen if steroid-responsive autoimmune pancreatitis is suspected.

  7. 07

    Managing

    HPB consultation

    Specialist hepato-pancreato-biliary review to plan endoscopic, medical or surgical management.

Typical timeline: hours to days for an acute diagnosis, weeks to characterise chronic disease.

Symptoms

What pancreatitis actually feels like.

From a sudden severe acute attack to the slow-burning symptoms of chronic disease — and the red flags that mean you need urgent care.

  • Epigastric pain to back

    Severe upper abdominal pain that bores through to the back — the classic pancreatitis pattern.

  • Nausea

    Persistent nausea often accompanies an acute pancreatitis attack.

  • Vomiting

    Frequent vomiting that offers little relief from the pain.

  • Weight loss (chronic)

    Progressive weight loss in chronic pancreatitis from malabsorption and reduced intake.

  • Fatty stools (steatorrhoea)

    Pale, oily, offensive stools that are hard to flush — a sign of exocrine failure.

  • Post-alcohol acute attack

    A severe attack of pain within hours to days of a heavy drinking episode.

  • Autoimmune features

    Painless jaundice, weight loss and raised IgG4 — the autoimmune pancreatitis picture.

  • Red flag

    Severe acute pancreatitis with SIRS or organ failure — call 999. Needs urgent hospital care.

Treatment

How pancreatitis is treated in the UK.

Matched to whether the picture is acute, chronic or autoimmune — from IV fluids and cholecystectomy through to enzyme replacement and steroids.

  • IV fluids and analgesia

    The cornerstone of acute pancreatitis care — aggressive fluid resuscitation and adequate pain control.

  • Treat the cause

    Cholecystectomy after gallstone (biliary) pancreatitis, ideally on the same admission where possible.

  • Alcohol cessation

    Complete abstinence is essential in alcohol-related pancreatitis to prevent recurrence and progression.

  • Pancreatic enzyme replacement

    Pancreatin (Creon) taken with food restores digestion in chronic pancreatitis with exocrine failure.

  • Vitamin ADEK repletion

    Fat-soluble vitamins are frequently deficient in chronic pancreatitis and need active replacement.

  • Insulin for type 3c diabetes

    Pancreatogenic diabetes usually needs insulin; oral agents alone rarely give adequate control.

  • Steroids for autoimmune pancreatitis

    Autoimmune pancreatitis is highly steroid-responsive — a defining feature of the diagnosis.

  • Endoscopic / surgical drainage

    Symptomatic or infected pseudocysts may need endoscopic or surgical drainage in a specialist centre.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or specialist knows your history and can tell you which parts apply to you. If in doubt, seek assessment — especially with any red-flag features.

  • NICE. Pancreatitis (NG104).

  • British Society of Gastroenterology. Guidelines on pancreatitis and pancreatic disease.

  • American Pancreatic Association. Practice guidelines on acute and chronic pancreatitis.

  • Pancreatic Cancer UK. Information on pancreatic disease and cancer risk.

Red flags

When pancreatitis becomes an emergency.

Most pancreatitis is managed on a standard ward. These patterns tip into critical illness — do not delay.

  • Severe acute pancreatitis

    Acute pancreatitis with SIRS or organ failure — needs critical care and urgent HPB input.

  • Necrotising pancreatitis

    Pancreatic necrosis on CT — high mortality; needs specialist multidisciplinary management.

  • Pseudocyst rupture or bleed

    Sudden severe pain, shock or GI bleed — an emergency needing immediate intervention.

  • Cholangitis with pancreatitis

    Fever, jaundice and pancreatitis — needs urgent ERCP and antibiotics.

  • Cancer in chronic pancreatitis

    Chronic pancreatitis carries a raised pancreatic cancer risk — new red-flag features need urgent imaging.

  • Weight loss and jaundice

    Painless jaundice with weight loss — suspect pancreatic head cancer until proven otherwise.

  • Post-ERCP pancreatitis

    Severe abdominal pain and raised amylase after ERCP — a recognised, sometimes serious, complication.

  • Post-operative pancreatic leak

    New pain, fever or drain output after pancreatic surgery — needs urgent surgical review.

  • Pregnancy pancreatitis

    Acute pancreatitis in pregnancy — needs specialist obstetric and HPB assessment without delay.

Living with it

Living well with a scarred pancreas.

Four things that make the biggest difference — alcohol, diet, diabetes and ongoing specialist review.

A quiet reminder

Do not push through repeat attacks.

Each acute attack scars the pancreas further — every recurrence is a chance to fix the cause before chronic disease sets in.

  1. 01 Alcohol

    Complete abstinence in alcohol-related disease

    Continued drinking drives recurrence and irreversible damage — full abstinence is the single most important step.

  2. 02 Diet

    Small, low-fat meals with enzymes

    Frequent small meals with pancreatic enzyme replacement help manage steatorrhoea and maintain weight.

  3. 03 Diabetes

    Watch for type 3c diabetes

    Chronic pancreatitis often causes brittle, insulin-requiring diabetes — early recognition matters.

  4. 04 Reviews

    Regular specialist follow-up

    Ongoing HPB and dietitian follow-up guards against complications, cancer and nutritional decline.

Frequently asked

Everything we get asked about pancreatitis.

Quick answers on causes, imaging, autoimmune disease, enzyme replacement and alcohol.

  • What is pancreatitis?

    Pancreatitis is inflammation of the pancreas. Acute pancreatitis is a sudden, sometimes life-threatening attack; chronic pancreatitis is long-standing damage leading to scarring, malabsorption and diabetes.

  • What causes pancreatitis?

    The two most common causes in the UK are gallstones and alcohol. Less common causes include high triglycerides, certain drugs, autoimmune disease, genetic conditions, trauma and ERCP.

  • How is acute pancreatitis diagnosed?

    Typical severe upper-abdominal pain plus a serum amylase or lipase level three times the upper limit of normal, supported by ultrasound and CT imaging where needed.

  • What is chronic pancreatitis?

    A long-standing inflammatory condition where the pancreas becomes scarred, losing its ability to produce digestive enzymes (exocrine failure) and insulin (endocrine failure).

  • What is autoimmune pancreatitis?

    A distinct, steroid-responsive form of pancreatitis, often linked to raised IgG4. It can mimic pancreatic cancer, so accurate diagnosis by a specialist team is essential.

  • Do I need to stop drinking completely?

    In alcohol-related pancreatitis, yes. Complete abstinence is the single most important step to prevent recurrence and slow progression to chronic disease.

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