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Health condition · Clinically reviewed

Pancreatitis, from sudden attack to long-term management.

Acute pancreatitis usually settles with the right treatment. Chronic pancreatitis needs a longer-term plan. Both start with getting the cause right.

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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 NG104 and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on acute and chronic pancreatitis, from Glasgow scoring to enzyme replacement.

Key facts

Pancreatitis at a glance.

The essentials, in plain English - what it is, what causes it, and how it's treated in the UK today.

  • Acute pancreatitis

    Sudden inflammation of the pancreas, most often from gallstones or alcohol - ranges from mild to severe with organ failure.

  • Chronic pancreatitis

    Long-term, progressive and irreversible damage, most commonly from years of heavy alcohol use.

  • Main causes

    Gallstones and alcohol together account for the great majority of cases in the UK - the mnemonic is "GET SMASHED".

  • Diagnosis

    Serum amylase or lipase, a CT scan for severity, and an ultrasound to look for gallstones.

  • Severity scoring

    Glasgow or APACHE II scores identify who needs high-dependency or intensive care early.

  • Long-term effects

    Chronic disease can lead to malabsorption, steatorrhoea, weight loss and pancreatic diabetes.

Why this guide matters

Getting the cause right changes everything.

Pancreatitis is common, and outcomes depend heavily on early, accurate assessment. The three points below shape everything else on this page.

  • Most acute attacks settle

    Supportive care - fluids, pain relief and treating the underlying cause - resolves the majority of acute episodes without lasting harm.

  • Severity must be assessed early

    Glasgow or APACHE II scoring in the first 48 hours identifies who needs higher-level care before complications develop.

  • Chronic disease needs a long-term plan

    Alcohol cessation, enzyme replacement and diabetes monitoring together slow progression and protect quality of life.

How the diagnosis is made

From severe pain to a clear plan.

The steps a UK hospital team will normally follow, per NICE NG104 - so you know what to expect and why.

  1. 01

    Assessing

    History and examination

    Sudden, severe epigastric pain radiating to the back, with nausea and vomiting, points strongly towards acute pancreatitis.

  2. 02

    Assessing

    Serum amylase or lipase

    A level more than three times the upper limit of normal supports the diagnosis - lipase is more specific and stays raised for longer.

  3. 03

    Confirming

    Abdominal ultrasound

    Looks for gallstones as the underlying cause and checks the bile ducts - usually done within 24 to 48 hours.

  4. 04

    Confirming

    CT abdomen for severity

    A contrast CT, typically after 72 hours, assesses necrosis, fluid collections and other complications in more severe cases.

  5. 05

    Confirming

    Glasgow or APACHE II scoring

    Blood results and clinical findings are combined into a severity score that guides the level of monitoring needed.

  6. 06

    Chronic assessment

    Assessing for chronic disease

    Recurrent attacks, persistent pain or malabsorption prompt CT, MRI or endoscopic ultrasound to look for structural change.

  7. 07

    Chronic assessment

    Faecal elastase and HbA1c

    Faecal elastase checks exocrine function and HbA1c screens for diabetes when chronic pancreatitis is suspected or confirmed.

Typical timeline: diagnosis within hours, severity confirmed within 72 hours.

Symptoms

What pancreatitis actually feels like.

Acute and chronic disease present differently - and some features mean it's time to seek urgent care.

  • Severe epigastric pain

    Sudden, severe upper abdominal pain, often radiating through to the back - the hallmark of an acute attack.

  • Nausea and vomiting

    Common alongside the pain and often persistent until the inflammation begins to settle.

  • Fever

    A raised temperature can accompany acute pancreatitis and may signal an evolving complication.

  • Shock in severe disease

    Low blood pressure, a fast heart rate and signs of organ failure mark severe, life-threatening attacks.

  • Recurrent abdominal pain

    In chronic disease, pain often becomes persistent or recurs in episodes over months or years.

  • Steatorrhoea

    Fatty, foul-smelling, pale stools that are hard to flush - a sign of fat malabsorption from enzyme insufficiency.

  • Weight loss

    Unintentional weight loss from malabsorption and reduced appetite is common in chronic pancreatitis.

  • Diabetes

    Progressive damage to the insulin-producing cells can cause pancreatic diabetes, sometimes years into the disease.

Treatment

How pancreatitis is treated in the UK.

Supportive care and treating the underlying cause for acute attacks - stepped, longer-term management for chronic disease.

  • IV fluids and analgesia

    The foundation of acute care - aggressive fluid resuscitation and strong pain relief while the pancreas settles.

  • Nutritional support

    Early oral or enteral feeding is now preferred over prolonged fasting, supporting gut function and recovery.

  • ERCP for gallstones

    Endoscopic removal of a stone blocking the bile duct, usually within 72 hours in gallstone pancreatitis with cholangitis.

  • Cholecystectomy

    Gallbladder removal, ideally during the same admission, to prevent a further attack from recurring gallstones.

  • Alcohol cessation support

    Structured advice and referral to alcohol services - essential in both acute and chronic alcohol-related disease.

  • HDU or ICU monitoring

    Severe disease with organ failure or extensive necrosis needs close monitoring and management of complications.

  • Pancreatic enzyme replacement

    Enzyme capsules taken with meals correct malabsorption and steatorrhoea in chronic pancreatitis.

  • Endoscopic or surgical intervention

    For strictures, stones or pseudocysts causing persistent chronic pain or obstruction that has not settled conservatively.

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 gastroenterologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Pancreatitis (NG104).

  • British Society of Gastroenterology. Guidelines on the management of acute pancreatitis.

  • Royal College of Surgeons. Commissioning guide for gallstone disease.

  • Diabetes UK. Guidance on pancreatic (type 3c) diabetes.

Red flags

When pancreatitis needs urgent attention.

Most attacks are manageable with prompt hospital care. These are the situations that need emergency or specialist review.

  • Signs of organ failure

    Falling blood pressure, breathlessness or reduced urine output in acute pancreatitis need emergency assessment.

  • Persistent or worsening fever

    Can signal infected necrosis or an abscess - usually needs repeat imaging and IV antibiotics.

  • Signs of shock

    A fast, weak pulse, cold extremities or confusion point to severe disease needing intensive care.

  • Jaundice

    Yellowing of the skin or eyes suggests a bile duct stone still obstructing flow - urgent ERCP may be needed.

  • Pseudocyst symptoms

    New or worsening abdominal pain, fullness or early satiety weeks after an attack can indicate a developing pseudocyst.

  • Uncontrolled chronic pain

    Pain that is not responding to the stepped analgesic approach deserves specialist pain or gastroenterology review.

  • New diabetes symptoms

    Unexplained thirst, tiredness or weight loss in someone with chronic pancreatitis should prompt an HbA1c check.

  • Ongoing alcohol use after diagnosis

    Continued drinking accelerates chronic damage - a clear signal to re-engage alcohol support services urgently.

  • Rapid, unexplained weight loss

    Alongside pain or a change in bowel habit, this warrants investigation to rule out a pancreatic mass.

Living with it

A manageable condition, with the right routine.

Four things that make the biggest difference day to day - stopping alcohol, taking enzymes properly, watching for diabetes, and staying in touch with your team.

A quiet reminder

Small, consistent habits protect the pancreas you have left.

Chronic damage doesn't reverse, but steady management slows it and keeps symptoms under control.

  1. 01 Alcohol

    Stop drinking completely

    The single biggest factor in preventing further attacks and slowing chronic damage - support is available and effective.

  2. 02 Nutrition

    Take enzymes with every meal

    Pancreatic enzyme capsules work best taken with food, not before or after - missing doses brings symptoms straight back.

  3. 03 Monitoring

    Watch for diabetes

    Regular HbA1c checks catch pancreatic diabetes early, when it is easier to manage.

  4. 04 Follow-up

    Keep gastroenterology appointments

    Chronic pancreatitis is a long-term condition - regular review adjusts pain control and catches complications early.

Frequently asked

Everything we get asked about pancreatitis.

Quick answers on causes, diagnosis, steatorrhoea and long-term outlook.

  • What is pancreatitis?

    Inflammation of the pancreas. Acute pancreatitis comes on suddenly, most often from gallstones or alcohol, and usually settles with treatment. Chronic pancreatitis is long-term, progressive damage, usually from years of heavy alcohol use, that does not reverse.

  • What causes acute pancreatitis?

    Gallstones and alcohol are the two leading causes in the UK, together accounting for the majority of cases. Less common causes include high triglycerides, certain medicines, infections and, rarely, a tumour blocking the pancreatic duct.

  • How is acute pancreatitis diagnosed?

    A raised serum amylase or lipase alongside typical pain supports the diagnosis. An ultrasound looks for gallstones, and a CT scan - usually after 72 hours - assesses severity and complications such as necrosis.

  • What does steatorrhoea mean?

    It describes pale, fatty, foul-smelling stools that are difficult to flush away. It happens when the pancreas no longer makes enough digestive enzymes, a common feature of chronic pancreatitis, and usually improves with enzyme replacement capsules.

  • Can pancreatitis cause diabetes?

    Yes. Chronic pancreatitis can progressively damage the insulin-producing cells of the pancreas, leading to what is sometimes called type 3c or pancreatogenic diabetes. Regular HbA1c monitoring picks this up early.

  • Is acute pancreatitis life-threatening?

    Most cases are mild and settle with fluids, pain relief and treatment of the underlying cause. A minority develop severe disease with organ failure or infected necrosis, which needs high-dependency or intensive care and carries a real risk to life.

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