Acute Pancreatitis

The pancreas is an organ that sits behind the stomach. It makes digestive juice to help break down food and hormones to control levels of sugar in the blood. Acute pancreatitis is a condition where the pancreas develops inflammation due to a variety of different triggers. This inflammation causes severe upper abdominal pain, alongside nausea, vomiting and fevers (Figure 1).

Figure 1: Pancreatic anatomy

In the UK, around 30,000 people are diagnosed with acute pancreatitis each year. Most people (4 out of 5) have a mild form of the condition, which can be treated with rest and basic supportive care (what we call ‘conservative management’), These patients have a low risk of death (less than 1%). However, for the remaining 20% of people, the condition is more serious and may require more advanced treatment. In severe cases, some people might need to be cared for in an intensive care unit (ICU), and unfortunately up to 25% (1 in 4) of people with severe pancreatitis may not survive.

The Royal Free Hospital and University College London Hospitals have created the North Central London (NCL) Acute Pancreatitis Network to ensure timely specialist advice, treatment and, if needed, transfers of patients with acute pancreatitis across the region. As most patients with mild disease improve without the need for complex treatment, the focus of this Network is for those with more severe disease with complications from this.

There are several causes of acute pancreatitis. The commonest are gallstones or small stone debris (‘sludge’) passing down the bile duct and blocking the pancreas, and high alcohol consumption. Together these account for up to 80% of pancreatitis attacks. Other causes include certain medications a high level of fats (‘triglycerides’) or calcium (a mineral) in the blood. Acute pancreatitis may also occur as a complication in patients undergoing a procedure called Endoscopic Retrograde Cholangiopancreatography (ERCP), which is done to diagnose and treat conditions of the bile ducts and pancreas. This occurs in approximately 2–10% of patients undergoing this procedure.

You will be investigated for the cause of the pancreatitis by the doctors at your hospital. Approximately 1 in 10 people a cause will not be found on initial investigations, and this may need more in-depth evaluation at a specialist pancreatic centre.

Acute pancreatitis is divided into ‘Mild’, ‘Moderate’ and ‘Severe’, each of which has a differing disease course and outcome.  

The majority of patients (80%) have mild disease where there are no effects on other organs in the body. These patients normally improve and are usually able to go home within 1–2 weeks of symptoms developing.

If other organs in the body are affected, this is termed ‘Moderate’ or ‘Severe’ pancreatitis. The organs affected include the kidney, lung and heart. The function of these is monitored with blood tests and bedside assessments such as blood pressure, heart rate, breathing rate and oxygen levels, and urine production.

Sometimes, people with pancreatitis develop complications where fluid or dead pancreatic tissue (‘pancreatic necrosis’) collects around the pancreas. These are called pseudocysts or walled-off pancreatic necrosis. If these collections cause problems or symptoms, they may need to be drained (see below).

These collections usually develop several weeks (often more than 4 weeks) after the pancreatitis starts. To keep track of these changes, doctors will often do several scans, like CT (computed tomography) or MRI (magnetic resonance imaging), while the patient is in hospital.

When someone has acute pancreatitis, the main treatment is to make sure they receive enough fluids, usually through a drip in the vein. Medicines can also help ease pain and nausea while the inflammation improves.

If an infection develops, either around the pancreas or elsewhere in the body, antibiotics might be needed to treat it.

It is best to eat and drink as soon as your condition allows and you to. If you can't eat enough by mouth, a feeding tube may be placed through your nose to deliver food directly to your stomach or intestines. This is usually better than getting nutrition through a drip.

These treatments are called "conservative management" because they don't involve surgery or other invasive procedures.

Sometimes, if a pseudocyst or walled-off pancreatic necrosis forms and causes problems, doctors might need to do more invasive treatments. The timing of these depends on how sick you are, how long it’s been since your pancreatitis started, and what the scans show.

If your illness affects other organs, you might need extra support in the intensive care unit. The doctors and specialists will decide the best care for you.

If you have a more serious form of pancreatitis or complications like fluid collections, it can help to get advice from a team of pancreas specialists. In the North Central London Acute Pancreatitis Network there is a team of doctors, nurses, and radiologists who are experts in caring for patients with acute pancreatitis. These specialists are based at two hospitals, University College London Hospitals and The Royal Free Hospital. This team, known as a ‘multidisciplinary team’, meets every week to review cases and discuss the best treatment plans. 

Your local hospital will continue to take care of you, but the specialist Network team will offer their expert advice to make sure you get the right tests and treatments. If your condition gets worse, your hospital team can contact the specialists for help at any time during the week. 

Sometimes, patients need a procedure to drain fluid collections in the pancreas or treat other complications. This is usually done using special techniques. One way is with an endoscopic ultrasound, which is a procedure that uses a thin, flexible camera along with ultrasound (sound waves) to take pictures inside your digestive system and nearby areas and place a ‘stent’ (a small plastic or metal tube) into the collection to drain it (see Figure 2 below). Another way is using a thin drainage tube inserted through the skin into the collection to drain it into a bag on the outside (‘percutaneous drainage’). The specialist team reviews these cases regularly to decide if, when and how procedures should be done. 

Most of the time, these procedures are done as a “day case,” meaning you come to the specialist centre, have the procedure, and then go back to your local hospital the same day. In more serious cases, you might need to be transferred to the specialist centre as an inpatient, especially if you need critical care support and are too unwell to return to your local hospital right away. 

Figure 2: Endoscopic ultrasound-guided drainage of pancreatic collection into the stomach (‘cyst gastrostomy’)

Your local hospital will keep you informed about the advice they receive from the specialist centre regarding your treatment. They will also let you know if you might need a procedure or need to be transferred to the specialist centre.

If you do need to go to the specialist centre, you may be transferred back to your local hospital when it is safe and appropriate. Sometimes, recovering from acute pancreatitis can take several months, and since the care and recovery are similar in any hospital, it is usually best for you to continue your rehabilitation nearer home.

Most patients will have their follow-up care close to home, with the same team that looked after them while they were in the hospital initially.

If you had treatment at a specialist centre, you may be asked to go back there for follow-up. However, some local hospitals have experts who can provide the required specialist follow up and therefore some patients may be followed up by them.

If your pancreatitis was caused by gallstones, it’s very important to talk about removing your gallbladder while you are still in the hospital. If alcohol caused your pancreatitis, you should meet with a member of the local alcohol support services during your stay. Stopping drinking alcohol is really important to help prevent the pancreatitis from coming back.

If you had a stent placed to drain a collection this will need to be removed later. If you haven’t heard from the hospital that put the stent in within two months, please get in touch with them to arrange when it will be taken out.

NHS website information about acute pancreatitis

Authors: Dr Simon Phillpotts & Dr Harry Martin (March 2025)

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