Looking after your pancreas: how to avoid acute pancreatitis

Acute pancreatitis is a serious condition affecting more and more of the UK population – and it’s estimated that 1 in 8 of cases are related to binge drinking. We asked leading gastroenterologist Dr Gavin Johnson what acute pancreatitis is, how to spot the signs, and what you can do to reduce your risk.

What is acute pancreatitis?

Pancreatitis means the pancreas has become inflamed. The pancreas is part of your digestive system, and sits just behind the stomach.

There are two types of pancreatitis: acute pancreatitis and chronic pancreatitis. In acute pancreatitis, symptoms of intense pain comes on quite rapidly, and ordinarily requires a few days in hospital for pain relief. However, 10% of all episodes are very severe and even life-threatening, and patients can spend months in hospital recovering. In chronic pancreatitis, the pancreas has become permanently damaged and this may either not produce any symptoms, or can lead to frequently or even constant severe abdominal pain.

What causes acute pancreatitis?

There are many things which can cause acute pancreatitis.

The most common cause is gallstones which travel down the bile duct and cause a block to the opening of the pancreas. Gallstone pancreatitis is seen most commonly in patients with gallbladder disease, which occurs most often in women over the age of 60, but can affect people of any age.

The next most common cause is alcohol consumption, particularly binge-drinking. Although there is a clear link between alcohol and pancreatitis, we are still working out exactly how alcohol causes the pancreas to become inflamed. Alcohol is also the predominant cause of chronic pancreatitis, which is also made worse by smoking.

Rarer causes can include trauma, infection (e.g. mumps) and certain kinds of medication.

In about 20% of cases, we don’t know why the pancreas has become inflamed – this is known as idiopathic pancreatitis.

How do I know if I have acute pancreatitis?

The main symptom of acute pancreatitis is severe abdominal pain that radiates to your back and is made worse from movement. It can also cause you to feel sick, vomit, sweat, or have a fast heart rate. The pain is usually bad enough for you to need to attend the Accident and Emergency department.

Acute pancreatitis is sometimes hard to differentiate from other urgent medical conditions, such as peptic ulcer disease or rupture of an abdominal aortic aneurysm. All of these are serious conditions, so it’s important to see a doctor immediately if you experience severe abdominal pain and any of the symptoms listed above.

What happens when I see the doctor?

The doctor will ask you about your symptoms and medical history, including any medication you currently take, and whether you drink or smoke. If they think you might have acute pancreatitis, you’ll be referred to hospital urgently.

In hospital, you’ll have a number of blood tests to help make a diagnosis, and scans to help identify the cause. Meanwhile – even before the diagnosis is confirmed – we’ll start on treatment, to reduce the chances of severe complications. This includes drugs to manage the pain and fluid replacement. After about a week symptoms are normally under control and you will be discharged. If the cause is due to gallstones then the gallbladder needs to be removed as soon as possible before another attack occurs.

How can I reduce my risk?

Reducing your alcohol consumption is one of the key ways to lower your risk of acute pancreatitis. It’s particularly important not to consume too much alcohol at once.

If you have acute pancreatitis, the medical team will focus on identifying the cause and treating it that so that you’re less likely to experience it again in the future. As mentioned, this can include surgery to remove the gallbladder. Finally, you should have a review of your medications to check if any might be responsible for your symptoms.

In chronic pancreatitis it is important that you do not drink or smoke. Treatment is centred around controlling the pain, which can be by medication, endoscopic treatment, or surgery is selected cases. You will be monitored to see if you need enzyme replacement tablets with meals to replace those that the pancreas may not now be producing, and also for the development of diabetes.