How is acute pancreatitis treated?

Photo of woman on a drip
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Acute pancreatitis ( of the ) usually clears up within one to two weeks. Solid foods are generally avoided for a while in order to reduce the strain on the . Supportive measures like an infusion (IV drip) to provide fluids and painkillers can help to relieve symptoms and prevent complications.

The main signs of acute pancreatitis are sudden and severe pain in the upper abdomen, nausea and vomiting. It is usually caused by gallstones blocking the opening of the pancreas or by drinking too much alcohol.

In 80% of people with acute pancreatitis, the either clears up completely or improves a lot within one to two weeks. But it sometimes leads to serious complications, so it’s usually treated in a hospital.

What is the most important first step in treating pancreatitis?

Acute pancreatitis causes the body to lose a lot of fluids quickly, which leads to a loss of important minerals too. Nausea and vomiting also make it difficult to drink enough fluids. This loss of fluids (dehydration) can cause complications such as low blood pressure or even circulatory failure. To prevent this from happening, the patient is put on a drip that supplies them with fluids and electrolytes.

Relieving the pain

Acute pancreatitis is usually very painful. There are a number of medications to relieve the pain. Strong painkillers (opioids) are often needed. Painkillers are also usually given through a drip or (epidural).

Sometimes it’s possible to adjust the dose of the painkiller on your own. This is called “patient-controlled analgesia” or PCA. You use a pump to control how much of the medicine is delivered. There are checks in place to prevent overdosing.

In the past, opioids such as morphine were used cautiously because it was feared that they would make it even harder for the digestive juices to flow out of the . But research has not found this to be true. So there is currently no reason not to treat acute pancreatitis pain with opioids.

Weaker painkillers like acetaminophen (paracetamol) or an NSAID like ibuprofen can be used once the pain starts to get better.

When can you start eating again?

Patients are no longer advised to stop eating completely. Research has shown that many people can start eating a little again as soon as their symptoms improve and they feel hungry. This is even true for people who have a higher risk of complications.

It's often possible to start eating solid foods after only one to two days. But doctors recommend starting off with food that can be easily digested and is low in fat. Still, if you feel nauseous, need to vomit or have complications such as a bowel obstruction (blockage), it's best to wait before eating solid foods again.

When is a feeding tube needed?

If it's not possible to start eating again within a few days, a feeding tube can be used to supply important nutrients such as proteins, carbohydrates, fats, vitamins and minerals in specially prepared liquid food. A feeding tube is inserted through the nose and gently pushed down through the food pipe to the stomach or small intestine.

In rare cases, parenteral nutrition may also be needed. This is where nutrients are delivered directly into the bloodstream using a drip. It may be needed if, for instance, your body can't absorb any food because digestion is too painful or because the tube can't be pushed far enough into the bowel. Whenever possible, a feeding tube is used instead of a drip. This is because many studies have shown that giving parenteral nutrition through a drip is associated with more infections and complications, and even with more deaths.

Can antibiotics or other medications prevent complications?

Acute pancreatitis can lead to infections. These can affect the itself or other organs, such as the lungs or the bile ducts. These infections are treated with .

It would be better to prevent infections in the first place, though. Antibiotics were often used as a preventive measure in the past, particularly if some of the tissue had died (pancreatic necrosis). This was done to keep the dead tissue from becoming infected and causing pancreatic necrosis. But studies have not clearly shown that taking as a precaution can prevent complications. Because the use of also leads to side effects and increases the likelihood of becoming resistant to them, experts no longer recommend routinely using as a precaution.

Several studies looked into whether the use of prebiotics or probiotics can prevent complications or influence how severe a case of pancreatitis becomes. These substances are believed to promote the growth of harmless lactic acid , lowering the risk of infections. But research hasn't found this to be true.

How are gallstones treated?

If acute pancreatitis is caused by gallstones, the stones can be removed using endoscopic retrograde cholangiography (ERC). This involves gently pushing an through your food pipe, your stomach, and the first part of the small intestine, to the opening of the bile duct. A contrast medium (dye-like substance) is then injected into the bile duct to make any stones that are there show up in an x-ray image. With the help of a small basket-like wire instrument at the tip of the , these stones can also be removed during the procedure.

If the pancreatitis was caused by gallstones, the gallbladder is usually removed too at a later time. This lowers the risk of more gallstones forming and the becoming inflamed again. About 20 out of 100 people who don’t have their gallbladder removed have another within a few months. If acute pancreatitis doesn't lead to any complications, the gallbladder can already be removed within the first few days of the hospital stay. The sooner it is removed, the earlier you can leave the hospital. According to research, there are no disadvantages of removing the gallbladder early on in uncomplicated cases of pancreatitis. In severe cases, or if there are complications, it's better to wait until the patient has had time to recover. Otherwise the risk of complications during the surgery is too high.

Severe cases of pancreatitis

In about 15 to 20 out of 100 cases, acute pancreatitis leads to complications affecting the or other organs. Pseudocysts (fluid-filled areas in the ) are a common complication. If they're small and don’t cause any symptoms, they don’t need to be treated. Larger pseudocysts may break open and bleed or become infected and form an abscess. To stop this from happening, the cyst can be punctured and drained from the outside using a hollow needle.

If dead tissue isn't infected, it doesn’t always need to be treated. Infected dead tissue has to be treated with , though. The dead tissue might have to be removed too. Various procedures are used to do this, depending on what part of the is affected. If the dead tissue isn’t causing any acute problems, doctors wait about four weeks before removing it so that the patient can recover from the acute illness first. By then the dead tissue will also have hardened, making it easier to tell it apart from healthy tissue and remove it.

If acute pancreatitis becomes very bad, the can spread to the entire body. This is referred to as systemic inflammatory response syndrome (SIRS). SIRS can cause single or multiple organ failure and has to be treated in an intensive care unit. There, doctors and nurses try to keep the organs functioning until the has passed.

What happens after recovery?

If a specific cause of acute pancreatitis was found, such as gallstones or a (rare) metabolic disorder, that cause is treated. Otherwise, no other treatments are generally needed after uncomplicated acute pancreatitis.

If the pancreatitis was alcohol-related, people are advised to drink a lot less alcohol afterwards. Many people find that hard to do. But there are a lot of practical tips and places that offer support if you're trying to cut down on drinking. There is no research on whether avoiding alcohol can help prevent pancreatitis from coming back if the cause isn’t alcohol-related.

People who had a severe case of acute pancreatitis with complications may need further treatment after leaving the hospital. Extreme weight loss is common during acute pancreatitis. It can sometimes take several weeks for your appetite to return and to put the weight back on. Advice from a nutritionist can help during this time. In some people, the doesn’t produce enough digestive juices (for a while) after the pancreatitis has cleared up. Then artificial enzymes can be taken with meals to help the body absorb fats in food. People who have had acute pancreatitis are also more likely to develop diabetes. The diabetes may then need to be treated as well.

Al-Omran M, Albalawi ZH, Tashkandi MF, Al-Ansary LA. Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database Syst Rev 2010; (1): CD002837.

Bakker OJ, van Brunschot S, van Santvoort HC, Besselink MG, Bollen TL, Boermeester MA et al. Early versus on-demand nasoenteric tube feeding in acute pancreatitis. N Engl J Med 2014; 371(21): 1983-1993.

Besselink M, van Santvoort H, Freeman M, Gardner T, Mayerle J, Vege SS et al. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13(4 Suppl 2): e1-15.

Boxhoorn L, Voermans RP, Bouwense SA et al. Acute pancreatitis. Lancet 2020; 396(10252): 726-734.

Gou S, Yang Z, Liu T, Wu H, Wang C. Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Crit Care 2014; 18(2): R57.

Hsieh PH, Su HY, Lin CY et al. Infection rate among nutritional therapies for acute pancreatitis: A systematic review with network meta-analysis of randomized controlled trials. PLoS One 2019; 14(7): e0219151.

Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ 2014; 349: g4859.

Meng W, Yuan J, Zhang C, Bai Z, Zhou W, Yan J et al. Parenteral analgesics for pain relief in acute pancreatitis: a systematic review. Pancreatology 2013; 13(3): 201-206.

Meng WB, Li X, Li YM, Zhou WC. Three initial diets for management of mild acute pancreatitis: a meta-analysis. World J Gastroenterol 2011; 17(37): 4235-4241.

Moody N, Adiamah A, Yanni F et al. Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis. Br J Surg 2019; 106(11): 1442-1451.

National Institute for Health and Care Excellence (NICE). Pancreatitis (NICE Guidelines; Volume NG104). 2020.

Poropat G, Giljaca V, Hauser G, timac D. Enteral nutrition formulations for acute pancreatitis. Cochrane Database Syst Rev 2015; (3): CD010605.

Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013; 108(9): 1400-1415; 1416.

Tian X, Pi YP, Liu XL et al. Supplemented Use of Pre-, Pro-, and Synbiotics in Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis of 13 Randomized Controlled Trials. Front Pharmacol 2018; 9: 690.

Vaughn VM, Shuster D, Rogers MAM, Mann J, Conte ML, Saint S et al. Early Versus Delayed Feeding in Patients With Acute Pancreatitis: A Systematic Review. Ann Intern Med 2017; 166(12): 883-892.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on May 25, 2021
Next planned update: 2024

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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