Definition
Pancreatitis is an inflammation of the pancreas classified as:

  • Acute pancreatitis: Acute inflammation often resolves with treatment.
  • Chronic pancreatitis: Long-term inflammation causes permanent pancreatic damage and functional impairment.

Pathogenesis

  • Acute pancreatitis: Most common causes are biliary lithiasis and excessive alcohol consumption. Other causes include infections, medications, and trauma.
  • Chronic pancreatitis: Develops after repeated episodes of acute pancreatitis, often due to chronic alcoholism, genetic factors, or autoimmune diseases.

Diagnosis
Diagnosis is based on clinical symptoms, laboratory tests, and imaging:

  • Acute pancreatitis: Characteristic symptoms include severe abdominal pain, nausea, and vomiting, with elevated blood amylase and lipase levels. CT scans help assess severity.
  • Chronic pancreatitis: Often associated with abdominal pain, malabsorption, and weight loss. Imaging findings such as pancreatic calcifications or atrophy confirm the diagnosis.

Treatment

  • Acute pancreatitis: Hospitalization with hydration, pain management, and fasting to rest the pancreas. Severe cases may require surgery or drainage of abscesses.
  • Chronic pancreatitis: Pain management, enzyme supplements for digestion, and avoidance of alcohol and fatty foods. Severe cases may require surgery to relieve pressure or remove damaged sections.

Early diagnosis and individualized treatment are necessary to prevent complications such as pancreatic insufficiency or pseudocysts and neoplasms.

Key figures: Diagnosis requires 2 of 3 criteria: characteristic pain, lipase or amylase at least 3 times the upper limit of normal, and compatible imaging. The first 24 to 48 hours of adequate fluid resuscitation are decisive. Prolonged fasting has been abandoned.

The commonest causes are gallstones and alcohol. The chronic form is a recognised risk factor for pancreatic cancer, and exocrine insufficiency is treated with enzyme replacement.

Key figures

  • Diagnosis requires 2 of 3 criteria: pain, enzymes 3x normal, imaging
  • The first 24 to 48 hours of fluid resuscitation are decisive
  • Enzyme level does not reflect severity
  • Antibiotics are not given routinely, only for documented infection

Frequently asked questions

How is acute pancreatitis diagnosed?

Two of three criteria are required: characteristic pain, lipase or amylase at least 3 times the upper limit of normal, and compatible imaging. Notably, the height of the enzyme rise does not reflect severity, so a very high lipase does not by itself indicate a severe attack.

What treatment is given?

The first 24 to 48 hours of adequate fluid resuscitation are decisive, together with analgesia and early resumption of oral intake once tolerated. Prolonged fasting has been abandoned. Antibiotics are not given routinely, only where infection is documented. If gallstones are the cause, cholecystectomy follows to prevent recurrence.

Does chronic pancreatitis lead to cancer?

It is a recognised risk factor, though the great majority of patients never develop pancreatic cancer. Chronic disease also causes exocrine insufficiency, treated with enzyme replacement, and diabetes from loss of insulin producing tissue. New onset diabetes in an older adult without obvious cause warrants assessment of the pancreas.

Sources


Content last updated: September 2026 (14/09/2026).