Private pancreatitis clinic in London, same-day gastroenterology.

Causes

• Gallstones — around half of cases. A stone blocks the duct where it joins the pancreatic duct.
• Alcohol — most of the remainder, usually after years of heavy drinking or a binge.
• High triglycerides — a recognised and treatable cause, often overlooked.
• Medicines — including azathioprine, some diuretics, valproate and GLP-1 agonists.
• After ERCP, trauma, high calcium, infections, and genetic causes.
• In a proportion no cause is found, and that warrants proper investigation rather than acceptance.

What happens in hospital

• Blood tests — amylase or lipase confirms the diagnosis, plus liver function, calcium, triglycerides and inflammatory markers.
• Ultrasound to look for gallstones; CT if the picture is unclear or complications are suspected.
• Intravenous fluids, pain relief and monitoring — the mainstay of treatment.
• Early feeding is now encouraged rather than prolonged starvation.
• Gallbladder removal during the same admission or within two weeks where gallstones were the cause — delaying it risks a further attack.

Chronic pancreatitis

Repeated or prolonged inflammation causes permanent scarring, so the pancreas stops producing enough digestive enzymes and insulin.

• Persistent or recurring upper abdominal pain, often worse after eating
• Pale, greasy, foul-smelling stools that float and are hard to flush — steatorrhoea, from undigested fat
• Weight loss despite eating normally, and vitamin deficiencies
• Diabetes, developing as insulin-producing cells are lost
• Alcohol is the commonest cause; smoking independently accelerates it

Living with chronic pancreatitis

• Complete alcohol abstinence and stopping smoking — the two things that most alter the course.
• Pancreatic enzyme replacement (PERT) with every meal and snack containing fat. Doses are commonly too low; if stools are still greasy, the dose needs increasing rather than the diet restricting further.
• Do not follow a very low fat diet. Modern practice is a normal-fat diet with adequate enzymes, because fat restriction causes malnutrition and vitamin deficiency.
• Fat-soluble vitamins (A, D, E, K) and bone density monitoring — osteoporosis is common and under-recognised.
• Diabetes screening at least annually.
• Specialist pain management; opioids are used cautiously.