Pancreatitis
 National Digestive Diseases Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

What is pancreatitis? 

Pancreatitis is inflammation of the pancreas. 

The pancreas is a large gland behind the 

stomach and close to the duodenum—the 

first part of the small intestine. The pancreas secretes digestive juices, or enzymes, 

into the duodenum through a tube called 

the pancreatic duct. Pancreatic enzymes 

join with bile—a liquid produced in the liver 

and stored in the gallbladder—to digest 

food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body 

regulate the glucose it takes from food for 

energy. 

Normally, digestive enzymes secreted by the 

pancreas do not become active until they 

reach the small intestine. But when the 

pancreas is inflamed, the enzymes inside it 

attack and damage the tissues that produce 

them. 

Pancreatitis can be acute or chronic. Either 

form is serious and can lead to complications. In severe cases, bleeding, infection, 

and permanent tissue damage may occur. 

Both forms of pancreatitis occur more often 

in men than women. 

Liver 

Gallbladder 

Duodenum 

Hepatic ducts 

Cystic duct 

Pancreas 

Common bile duct 

Pancreatic duct 

The gallbladder and the ducts that carry bile and 

other digestive enzymes from the liver, gallbladder, 

and pancreas to the small intestine are called the 

biliary system. 

What is acute pancreatitis? 

Acute pancreatitis is inflammation of the 

pancreas that occurs suddenly and usually 

resolves in a few days with treatment. 

Acute pancreatitis can be a life-threatening 

illness with severe complications. Each 

year, about 210,000 people in the United 

States are admitted to the hospital with 

acute pancreatitis.1 The most common 

cause of acute pancreatitis is the presence 

of gallstones—small, pebble-like substances 

made of hardened bile—that cause inflammation in the pancreas as they pass through 

1

Russo MW, Wei JT, Thiny MT, et al. Digestive 

and liver disease statistics, 2004. Gastroenterology. 

2004;126:1448–1453. 
the common bile duct. Chronic, heavy 

alcohol use is also a common cause. Acute 

pancreatitis can occur within hours or as 

long as 2 days after consuming alcohol. 

Other causes of acute pancreatitis include 

abdominal trauma, medications, infections, 

tumors, and genetic abnormalities of the 

pancreas. 

Symptoms 

Acute pancreatitis usually begins with gradual or sudden pain in the upper abdomen 

that sometimes extends through the back. 

The pain may be mild at first and feel worse 

after eating. But the pain is often severe 

and may become constant and last for several days. A person with acute pancreatitis 

usually looks and feels very ill and needs 

immediate medical attention. Other symptoms may include 

•	 a	swollen	and	tender	abdomen	

•	 nausea	and	vomiting	

•	 fever	

•	 a	rapid	pulse	

Severe acute pancreatitis may cause dehydration and low blood pressure. The heart, 

lungs, or kidneys can fail. If bleeding occurs 

in the pancreas, shock and even death may 

follow. 

Diagnosis 

While asking about a person’s medical history and conducting a thorough physical 

examination, the doctor will order a blood 

test to assist in the diagnosis. During acute 

pancreatitis, the blood contains at least 

three times the normal amount of amylase and lipase, digestive enzymes formed 

in the pancreas. Changes may also occur 

in other body chemicals such as glucose, 

calcium, magnesium, sodium, potassium, 

and bicarbonate. After the person’s condition improves, the levels usually return to 

normal. 

Diagnosing acute pancreatitis is often difficult because of the deep location of the 

pancreas. The doctor will likely order one 

or more of the following tests: 

•	 Abdominal ultrasound. Sound waves 

are sent toward the pancreas through 

a handheld device that a technician 

glides over the abdomen. The sound 

waves bounce off the pancreas, 

gallbladder, liver, and other organs, 

and their echoes make electrical 

impulses that create a picture—called 

a sonogram—on a video monitor. If 

gallstones are causing inflammation, 

the sound waves will also bounce off 

them, showing their location. 

2 Pancreatitis 
•	 Computerized tomography (CT) scan. 

The CT scan is a noninvasive x ray that 

produces three-dimensional pictures of 

parts of the body. The person lies on 

a table that slides into a donut-shaped 

machine. The test may show gallstones 

and the extent of damage to the pancreas. 

•	 Endoscopic ultrasound (EUS). After 

spraying a solution to numb the 

patient’s throat, the doctor inserts an 

endoscope—a thin, flexible, lighted 

tube—down the throat, through the 

stomach, and into the small intestine. 

The doctor turns on an ultrasound 

attachment to the scope that produces 

sound waves to create visual images of 

the pancreas and bile ducts. 

•	 Magnetic resonance cholangiopancreatography (MRCP). MRCP uses 

magnetic resonance imaging, a noninvasive test that produces cross-section 

images of parts of the body. After 

being lightly sedated, the patient lies 

in a cylinder-like tube for the test. The 

technician injects dye into the patient’s 

veins that helps show the pancreas, 

gallbladder, and pancreatic and bile 

ducts. 

Treatment 

Treatment for acute pancreatitis requires 

a few days’ stay in the hospital for intravenous (IV) fluids, antibiotics, and medication 

to relieve pain. The person cannot eat or 

drink so the pancreas can rest. If vomiting 

occurs, a tube may be placed through the 

nose and into the stomach to remove fluid 

and air. 

Unless complications arise, acute pancreatitis usually resolves in a few days. In severe 

cases, the person may require nasogastric 

feeding—a special liquid given in a long, 

thin tube inserted through the nose and 

throat and into the stomach—for several 

weeks while the pancreas heals. 

Before leaving the hospital, the person will 

be advised not to smoke, drink alcoholic 

beverages, or eat fatty meals. In some 

cases, the cause of the pancreatitis is clear, 

but in others, more tests are needed after 

the person is discharged and the pancreas is 

healed. 

3 Pancreatitis 
Therapeutic Endoscopic Retrograde Cholangiopancreatography 

(ERCP) for Acute and Chronic Pancreatitis 

ERCP is a specialized technique used to 

view the pancreas, gallbladder, and bile 

ducts and treat complications of acute 

and chronic pancreatitis—gallstones, 

narrowing or blockage of the pancreatic 

duct or bile ducts, leaks in the bile ducts, 

and pseudocysts—accumulations of fluid 

and tissue debris. 

Soon after a person is admitted to the 

hospital with suspected narrowing of the 

pancreatic duct or bile ducts, a physician 

with specialized training performs ERCP. 

After lightly sedating the patient and 

giving medication to numb the throat, the 

doctor inserts an endoscope—a long, 

flexible, lighted tube with a camera— 

through the mouth, throat, and stomach 

into the small intestine. The endoscope is 

connected to a computer and screen. The 

doctor guides the endoscope and injects 

a special dye into the pancreatic or bile 

ducts that helps the pancreas, gallbladder, 

and bile ducts appear on the screen while 

x rays are taken. 

The following procedures can be performed using ERCP: 

Sphincterotomy. Using a small wire on 

the endoscope, the doctor finds the muscle that surrounds the pancreatic duct or 

bile ducts and makes a tiny cut to enlarge 

the duct opening. When a pseudocyst is 

present, the duct is drained. 

Gallstone removal. The endoscope is 

used to remove pancreatic or bile duct 

stones with a tiny basket. Gallstone 

removal is sometimes performed along 

with a sphincterotomy. 

Stent placement. Using the endoscope, 

the doctor places a tiny piece of plastic 

or metal that looks like a straw in a narrowed pancreatic or bile duct to keep it 

open. 

Balloon dilatation. Some endoscopes 

have a small balloon that the doctor uses 

to dilate, or stretch, a narrowed pancreatic or bile duct. A temporary stent may 

be placed for a few months to keep the 

duct open. 

People who undergo therapeutic ERCP 

are at slight risk for complications, including severe pancreatitis, infection, bowel 

perforation, or bleeding. Complications 

of ERCP are more common in people 

with acute or recurrent pancreatitis. A 

patient who experiences fever, trouble 

swallowing, or increased throat, chest, 

or abdominal pain after the procedure 

should notify a doctor immediately. 

Complications 

Gallstones that cause acute pancreatitis 

require surgical removal of the stones 

and the gallbladder. If the pancreatitis 

is mild, gallbladder removal—called 

cholecystectomy—may proceed while the 

person is in the hospital. If the pancreatitis 

is severe, gallstones may be removed 

using therapeutic endoscopic retrograde 

cholangiopancreatography (ERCP)—a 

specialized technique used to view the 

pancreas, gallbladder, and bile ducts and 

treat complications of acute and chronic 

pancreatitis. Cholecystectomy is delayed 

for a month or more to allow for full 

recovery. For more information, see the 

4 Pancreatitis 
Gallstones fact sheet from the National 

Institute of Diabetes and Digestive and 

Kidney Diseases (NIDDK). 

If an infection develops, ERCP or surgery 

may be needed to drain the infected area, 

also called an abscess. Exploratory surgery 

may also be necessary to find the source 

of any bleeding, to rule out conditions that 

resemble pancreatitis, or to remove severely 

damaged pancreatic tissue. 

Pseudocysts—accumulations of fluid and 

tissue debris—that may develop in the pancreas can be drained using ERCP or EUS. 

If pseudocysts are left untreated, enzymes 

and toxins can enter the bloodstream and 

affect the heart, lungs, kidneys, or other 

organs. 

Acute pancreatitis sometimes causes kidney 

failure. People with kidney failure need 

blood-cleansing treatments called dialysis or 

a kidney transplant. 

In rare cases, acute pancreatitis can cause 

breathing problems. Hypoxia, a condition 

that occurs when body cells and tissues do 

not get enough oxygen, can develop. Doctors treat hypoxia by giving oxygen to the 

patient. Some people still experience lung 

failure—even with oxygen—and require a 

respirator for a while to help them breathe. 

What is chronic 

pancreatitis? 

Chronic pancreatitis is inflammation of the 

pancreas that does not heal or improve—it 

gets worse over time and leads to permanent damage. Chronic pancreatitis, like 

acute pancreatitis, occurs when digestive 

enzymes attack the pancreas and nearby 

tissues, causing episodes of pain. Chronic 

pancreatitis often develops in people who 

are between the ages of 30 and 40. 

The most common cause of chronic pancreatitis is many years of heavy alcohol use. 

The chronic form of pancreatitis can be triggered by one acute attack that damages the 

pancreatic duct. The damaged duct causes 

the pancreas to become inflamed. Scar 

tissue develops and the pancreas is slowly 

destroyed. 

Other causes of chronic pancreatitis are 

•	 hereditary	disorders	of	the	pancreas	

•	 cystic	fibrosis—the	most	common	

inherited disorder leading to chronic 

pancreatitis 

•	 hypercalcemia—high	levels	of	calcium	

in the blood 

•	 hyperlipidemia	or	hypertriglyceridemia—high levels of blood fats 

•	 some	medicines	

•	 certain	autoimmune	conditions

•	 unknown	causes	

Hereditary pancreatitis can present in a 

person younger than age 30, but it might not 

be diagnosed for several years. Episodes of 

abdominal pain and diarrhea lasting several 

days come and go over time and can progress to chronic pancreatitis. A diagnosis of 

hereditary pancreatitis is likely if the person 

has two or more family members with pancreatitis in more than one generation. 

Symptoms 

Most people with chronic pancreatitis 

experience upper abdominal pain, although 

some people have no pain at all. The pain 

may spread to the back, feel worse when 

eating or drinking, and become constant 

and disabling. In some cases, abdominal 

5 Pancreatitis 
pain goes away as the condition worsens, 

most likely because the pancreas is no longer making digestive enzymes. Other symptoms include 

•	 nausea

•	 vomiting

•	 weight	loss

•	 diarrhea

•	 oily	stools

People with chronic pancreatitis often lose 

weight, even when their appetite and eating 

habits are normal. The weight loss occurs 

because the body does not secrete enough 

pancreatic enzymes to digest food, so nutrients are not absorbed normally. Poor digestion leads to malnutrition due to excretion 

of fat in the stool. 

Diagnosis 

Chronic pancreatitis is often confused with 

acute pancreatitis because the symptoms 

are similar. As with acute pancreatitis, the 

doctor will conduct a thorough medical history and physical examination. Blood tests 

may help the doctor know if the pancreas 

is still making enough digestive enzymes, 

but sometimes these enzymes appear normal even though the person has chronic 

pancreatitis. 

In more advanced stages of pancreatitis, 

when malabsorption and diabetes can occur, 

the doctor may order blood, urine, and stool 

tests to help diagnose chronic pancreatitis 

and monitor its progression. 

After ordering x rays of the abdomen, the 

doctor will conduct one or more of the 

tests used to diagnose acute pancreatitis— 

abdominal ultrasound, CT scan, EUS, and 

MRCP. 

Treatment 

Treatment for chronic pancreatitis may 

require hospitalization for pain management, IV hydration, and nutritional support. 

Nasogastric feedings may be necessary for 

several weeks if the person continues to lose 

weight. 

When a normal diet is resumed, the doctor 

may prescribe synthetic pancreatic enzymes 

if the pancreas does not secrete enough of 

its own. The enzymes should be taken with 

every meal to help the person digest food 

and regain some weight. The next step is to 

plan a nutritious diet that is low in fat and 

includes small, frequent meals. A dietitian 

can assist in developing a meal plan. Drinking plenty of fluids and limiting caffeinated 

beverages is also important. 

People with chronic pancreatitis are 

strongly advised not to smoke or consume 

alcoholic beverages, even if the pancreatitis 

is mild or in the early stages. 

Complications 

People with chronic pancreatitis who continue to consume large amounts of alcohol 

may develop sudden bouts of severe abdominal pain. 

As with acute pancreatitis, ERCP is used to 

identify and treat complications associated 

with chronic pancreatitis such as gallstones, 

pseudocysts, and narrowing or obstruction 

of the ducts. Chronic pancreatitis also can 

lead to calcification of the pancreas, which 

means the pancreatic tissue hardens from 

deposits of insoluble calcium salts. Surgery 

may be necessary to remove part of the 

pancreas. 

In cases involving persistent pain, surgery 

or other procedures are sometimes recommended to block the nerves in the abdominal area that cause pain. 

6 Pancreatitis 
When pancreatic tissue is destroyed in 

chronic pancreatitis and the insulinproducing cells of the pancreas, called 

beta cells, have been damaged, diabetes 

may develop. People with a family history 

of diabetes are more likely to develop the 

disease. If diabetes occurs, insulin or other 

medicines are needed to keep blood glucose 

at normal levels. A health care provider 

works with the patient to develop a regimen 

of medication, diet, and frequent blood glucose monitoring. 

For more information about diabetes, see 

the booklet Your Guide to Diabetes: Type 1 

and Type 2 from the NIDDK. 

How common is pancreatitis 

in children? 

Chronic pancreatitis in children is rare. 

Trauma to the pancreas and hereditary pancreatitis are two known causes of childhood 

pancreatitis. Children with cystic fibrosis— 

a progressive and incurable lung disease— 

may be at risk of developing pancreatitis. 

But more often the cause of pancreatitis in 

children is unknown. 

Hope through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases’ Division of 

Digestive Diseases and Nutrition supports 

basic and clinical research into gastrointestinal diseases, including the causes of pancreatitis and cell injury in the gastrointestinal 

tract. In addition, researchers are studying 

the genetics of hereditary pancreatitis and 

risk factors such as cystic fibrosis. 

Participants in clinical trials can play a more 

active role in their own health care, gain 

access to new research treatments before 

they are widely available, and help others 

by contributing to medical research. For 

information about current studies, visit 

www.ClinicalTrials.gov. 

Points to Remember 

•	 Pancreatitis	is	inflammation	of	

the pancreas, causing digestive 

enzymes to become active inside 

the pancreas and damage pancreatic tissue. 

•	 Pancreatitis	has	two	forms:		acute	

and chronic. 

•	 Common	causes	of	pancreatitis	are	

gallstones and heavy alcohol use. 

•	 Sometimes	the	cause	of	pancreatitis cannot be found. 

•	 Symptoms	of	acute	pancreatitis	

include abdominal pain, nausea, 

vomiting, fever, and a rapid pulse. 

•	 Treatment	for	acute	pancreatitis	

includes intravenous (IV) fluids, 

antibiotics, and pain medications. 

Surgery is sometimes needed to 

treat complications. 

•	 Acute	pancreatitis	can	become	

chronic if pancreatic tissue is permanently destroyed and scarring 

develops. 

•	 Symptoms	of	chronic	pancreatitis	

include abdominal pain, nausea, 

vomiting, weight loss, diarrhea, and 

oily stools. 

•	 Treatment	for	chronic	pancreatitis	

may involve IV fluids; pain medication; a low-fat, nutritious diet; and 

enzyme supplements. Surgery may 

be necessary to remove part of the 

pancreas. 

7 Pancreatitis 
For More Information

American Dietetic Association

120 South Riverside Plaza, Suite 2000

Chicago, IL 60606–6995

Phone: 1–800–877–1600 or 312–899–0040

Fax: 312–899–4899

Email: knowledge@eatright.org 

Internet: www.eatright.org

American Gastroenterological Association

4930 Del Ray Avenue

Bethesda, MD 20814

Phone: 301–654–2055

Fax: 301–654–5920

Email: member@gastro.org

Internet: www.gastro.org 

American Pancreatic Association

P.O. Box 14906

Minneapolis, MN 55414

Phone: 612–626–9797

Fax: 612–625–7700

Email: apa@umn.edu 

Internet: www.american-pancreatic-

 association.org

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications. When prepared, this publication included

the most current information available. For updates 

or for questions about any medications, contact 

the U.S. Food and Drug Administration toll-free at 

1–888–INFO–FDA (463–6332) or visit www.fda.gov. 

Consult your doctor for more information.

National Digestive Diseases 

Information Clearinghouse

2 Information Way

Bethesda, MD 20892–3570

Phone: 1–800–891–5389

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: nddic@info.niddk.nih.gov 

Internet: www.digestive.niddk.nih.gov

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service 

of the National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK). 

The NIDDK is part of the National Institutes of Health of the U.S. Department of 

Health and Human Services. Established in 

1980, the Clearinghouse provides information about digestive diseases to people with 

digestive disorders and to their families, 

health care professionals, and the public. 

The NDDIC answers inquiries, develops 

and distributes publications, and works 

closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK scientists and outside experts. This publication 

was originally reviewed by David C. Whitcomb, M.D., University of Pittsburgh. 

This publication is not copyrighted. The Clearinghouse encourages users of this fact sheet to duplicate 

and distribute as many copies as desired.

This fact sheet is also available at 

www.digestive.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

National Institutes of Health

NIH Publication No. 08–1596

July 2008