Pancreatitis is a condition characterized by inflammation of your pancreas, an organ in the lower part of your stomach that helps your body break down food for digestion. Some people experience an isolated episode, termed acute pancreatitis. Other people experience multiple episodes and more lasting pain, called chronic pancreatitis. Treatment to reduce symptoms of acute and chronic pancreatitis overlaps, but with some important distinctions.
Management of abdominal pain is a key component of treating acute pancreatitis, and additional supportive treatment can help reduce symptoms. In some cases, your healthcare provider may also help you address the root cause of the pancreatitis, like a gallstone obstruction.
A minority of people with acute pancreatitis have severe disease with complications and need intensive monitoring and care. The goal is to stabilize the person and prevent further complications and mortality.
Pain management is also a key aspect of treating chronic pancreatitis. Unfortunately, there is not always a good way to treat the root cause, although not smoking and decreasing alcohol intake may help. Pain medications can provide some relief, and certain medical procedures are sometimes helpful.
Some people with both acute and chronic pancreatitis also need treatment to replace the normal function of the pancreas, which makes the hormone insulin and certain digestive enzymes.
People with acute pancreatitis usually need to be hospitalized. Initially, the goal of treatment is to decrease your symptoms and reduce your chances of experiencing complications from pancreatitis. Depending on the root cause, your healthcare provider (like a gastroenterologist, which is a doctor who specializes in the digestive system) may not directly treat the pancreatitis itself. Some important aspects of treatment include:
- Providing additional oxygen
- Giving additional fluids into your veins
- Reducing pain via medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or stronger opioid medications like morphine, if needed
In the past, people with pancreatitis were often instructed to fast (not eat for a period of time). However, more recent guidelines encourage eating as soon as you are able, providing liquid nutrition or nutrition through a feeding tube (i.e. running from your nose down into your stomach), if needed.
Some, but not all, people with acute pancreatitis also need additional treatment because the pancreas can’t sufficiently perform its normal function of making digestive enzymes and insulin. If this is the case for you, you may need temporary treatment with insulin to manage your blood sugar (glucose) levels, which can become abnormally high. You may also need additional digestive enzymes to help you digest food.
Treatments for Specific Causes of Acute Pancreatitis
A subgroup of people with acute pancreatitis may need additional treatments depending on what's causing their case. These treatments are used to help manage current symptoms and prevent future episodes.
For example, gallstones are one of the most common causes of pancreatitis. Options for people with gallstones causing their pancreatitis might include:
- Cholecystectomy, which is the surgical removal of the gallbladder
- Endoscopic retrograde cholangiopancreatography (ERCP), a procedure which uses a long tube down your mouth and into the ducts around your pancreas to remove a gallstone
Very heavy alcohol consumption is also one of the most common causes of pancreatitis; therefore, counseling or therapies to aid in abstinence may be helpful.
If your pancreatitis is caused by high levels of triglycerides, medications can be used to help lower your levels. If you hav an underlying autoimmune disease causing pancreatitis, you might need corticosteroids or other immune-modulating treatments to correct your abnormal immune response.
Severe Acute Pancreatitis With Complications
Most cases of pancreatitis are mild. However, severe pancreatitis can cause more serious symptoms, and it can even be fatal. For example, if part of the pancreas dies, it can become infected. This can lead to sepsis, a life-threatening immune response.
For that reason, people with severe acute pancreatitis may need to receive more monitoring and additional treatment in an intensive care unit (ICU), in addition to the measures already discussed. Some of these might include (if needed):
- Endotracheal intubation (a tube in one’s throat), to support breathing
- Additional intravenous (IV) fluids to help correct electrolyte (mineral) abnormalities
- Medications to increase blood pressure if it is very low
- Hemodialysis if your kidneys aren’t working well, which is a procedure that filters your blood so your kidneys don't have to
- Tube feeding, or nutrition given through the veins
Some health professionals also prescribe antibiotics to prevent infection if part of the pancreas dies from the pancreatitis. This was often done in the past, but as of 2018 the American Gastroenterological Association recommends against antibiotics.
Additionally, some people with severe acute pancreatitis may need medical procedures or surgery. Some examples are:
- Percutaneous procedures, in which a needle is inserted through your skin to remove excess fluid around the pancreas.
- Endoscopic procedures, in which a long tube is inserted down your mouth and into the area around the pancreas to remove excess fluid.
- Surgery to remove dead pancreas tissue and prevent the spread of infection.
Treatments for Chronic Pancreatitis
Chronic pancreatitis can cause significant abdominal pain. In some people it comes and goes, but in others it is more constant. Unfortunately, abdominal pain from chronic pancreatitis is often difficult to adequately treat. Some medications sometimes used for this include:
- Tylenol (acetaminophen)
- Neurontin (gabapentin)
- Lyrica (pregabalin)
- Elavil (amitriptyline)
Because of the risk of dependence and other side effects, narcotic pain medications like Vidocin (hydrocodone) are only used if absolutely necessary.
A variety of medical surgeries can be helpful for some people. This is particularly true if you have an anatomical problem causing your pancreatitis, gallstone obstruction, or collections of leaked pancreatic fluids (called pseudocysts). Some possible interventions include:
- Procedures to temporarily stop pain signals from nerves in the area (e.g., celiac plexus nerve block)
- Extracorporeal shockwave lithotripsy (ESWL), which uses shock waves to break up gallstones
- Endoscopic approaches, which use a long tube passed down your throat, such as a procedure to place a stent in part of the pancreas’ ducts
- Surgical approaches, such as pancreatectomy (removing part or all of the pancreas)
Eating smaller but more frequent low-fat meals may also help some people reduce their pain.
Complications From Chronic Pancreatitis
Some people with chronic pancreatitis need treatment for complications from pancreatitis. Some examples are:
- Diabetes: This causes elevated levels of glucose in the blood due to pancreas damage. Treatment may include insulin, metformin, or related therapies.
- Lack of digestive enzymes from pancreas damage: This can lead to symptoms like bloating and problems from malnutrition. You may need supplemental digestive enzymes and additional vitamins like A and E.
- Osteoporosis and increased risk of fracture: You may need extra calcium, vitamin D, or anti-osteoporotic drugs.
- Pancreatic cancer: This type of cancer affects roughly 4% of people with chronic pancreatitis within 20 years of diagnosis. You might ultimately need standard treatments like chemotherapy and surgery.
About 20% of people who go through a bout of acute pancreatitis go on to have at least one more episode. About half of those people eventually develop chronic pancreatitis.
However, not smoking or consuming alcohol can substantially lower your risk, and can help prevent chronic pancreatitis from getting worse. It’s important to get whatever help you need to quit or lower your use, if necessary.
People with chronic pancreatitis also need regular monitoring for complications of the disease, like diabetes. About 10% of people with chronic pancreatitis develop permanent diabetes as a result.
People with chronic pancreatitis are also roughly 25% more likely to die within 10 years than people who don’t have pancreatitis. However, by managing your overall health, including risk factors for heart disease, you may be able to decrease this risk.
Long-term pain from chronic pancreatitis can significantly impact your quality of life and your mood. It's important to get support from people who can help your mental health and support you through your treatment journey. Iif you haven’t yet found adequate pain relief, keep working with your medical team to see if another approach (e.g., a medical procedure) might be right for you.
A Quick Review
Treatments for acute and chronic pancreatitis can overlap, although there are some important distinctions.Acute pancreatitis needs supportive treatment, such as fluids. Fewer people experience severe acute pancreatitis, which needs more intensive interventions. The long-term pain from chronic pancreatitis can be difficult to treat, but some medications and medical procedures may help. Not smoking and decreasing alcohol use are critical in preventing chronic pancreatitis and decreasing its impact.