Understanding your condition and how it is managed.
This leaflet explains chronic pancreatitis: what it is, what happens inside the pancreas, the symptoms and complications it can cause, common causes, how it is diagnosed, and how it is managed, including lifestyle changes, pain relief, nutrition, and endoscopic or surgical treatment. It is general background information and does not replace advice from your own specialist team, who will tailor your care to your individual situation.
Chronic pancreatitis is long-standing, ongoing inflammation of the pancreas that causes permanent, irreversible changes to its structure over time. Unlike acute pancreatitis, which is a sudden episode that usually resolves, chronic pancreatitis is a persistent condition, although some people also have flare-ups on top of their background symptoms, sometimes called "acute-on-chronic" episodes.
Over months or years, repeated inflammation gradually damages both parts of the pancreas: the exocrine tissue that makes digestive enzymes, and the endocrine tissue (islets) that makes insulin. This is why chronic pancreatitis can eventually affect both digestion and blood sugar control, alongside causing pain.
Chronic inflammation leads to a number of structural changes within the gland, described below. Not everyone develops all of these, and the pattern and severity varies between individuals.
Chronic pancreatitis also increases the long-term risk of pancreatic cancer, which is one reason why ongoing monitoring and follow-up are recommended (see "Possible complications" below).
The most common symptom is abdominal pain, though the pattern varies a great deal between individuals: some people have occasional severe flares, some have constant background pain with flares on top, and some have persistent, unrelenting pain. Typical features include:
Some people with chronic pancreatitis have relatively mild or intermittent symptoms for a long time; in others, the condition and its symptoms progress more quickly. It is difficult to predict this in advance, which is why regular follow-up is valuable.
Several factors contribute to chronic pancreatitis, and more than one often plays a role. Importantly, your team will not simply assume your pancreatitis is caused by alcohol just because you drink; a proper assessment is made for other possible causes too.
In a significant proportion of people, no clear cause is found even after thorough investigation ("idiopathic" chronic pancreatitis).
Diagnosis is based on a combination of your symptoms, examination, and tests. Imaging is central to confirming the diagnosis and looking for the structural changes described above:
A biopsy of the pancreas is not usually needed to make the diagnosis.
As enzyme-producing tissue is lost, your pancreas may no longer make enough enzymes to digest food properly, particularly fat. This causes weight loss and steatorrhoea, and is treated with pancreatic enzyme replacement therapy (PERT). See our separate "Nutrition in Pancreatitis" leaflet for detail on how this works and how to take it.
Damage to the insulin-producing islet cells can lead to diabetes (sometimes called type 3c or "pancreatogenic" diabetes), with a lifetime risk of up to around 80% in chronic pancreatitis. Because of this, your HbA1c (blood sugar control) is usually checked at least every six months, even if you feel well, so that diabetes can be identified and managed early.
Reduced absorption of calcium and vitamin D, alongside chronic inflammation, increases the risk of osteoporosis and osteopenia (thinning of the bones). A bone density scan is generally recommended every two years to monitor this.
Scarring in the head of the pancreas can narrow the nearby bile duct, which can cause jaundice (yellowing of the skin or eyes), itching, or dark urine, and may need a stent or surgery to relieve.
These fluid-filled collections can develop around the pancreas. Many cause no problems and are simply monitored, but if they become large, infected, or cause symptoms, they can be drained, usually with an endoscopic (camera-guided) procedure.
Chronic pancreatitis is associated with an increased long-term risk of pancreatic cancer, and this risk is substantially higher in hereditary pancreatitis, where lifetime risk can reach around 40%. If you have hereditary pancreatitis, your team may recommend annual monitoring; for other causes of chronic pancreatitis, you should discuss with your team whether any specific monitoring applies to you, and always report new or changing symptoms (such as unexplained weight loss, worsening pain, or jaundice) promptly.
There is no single treatment that reverses the structural damage already done to the pancreas, so management focuses on relieving symptoms, treating complications, slowing further damage, and supporting your nutrition and quality of life. Care usually involves a team that may include surgeons, gastroenterologists, dietitians, pain specialists, diabetes specialists, and psychological support.
Pain is often the most difficult symptom to manage and treatment is usually stepped up gradually: starting with simple painkillers, and progressing where needed to medicines also used for nerve-related (neuropathic) pain, such as pregabalin, gabapentin or certain antidepressants (SNRIs). For some people, a nerve block (coeliac plexus block) or referral to a specialist pain management team is helpful, and psychological support (such as cognitive behavioural therapy) can be a valuable part of managing persistent pain alongside medical treatment.
A dietitian can help you maintain a healthy weight and manage symptoms through diet. If you have exocrine insufficiency, pancreatic enzyme replacement therapy (PERT) taken with meals and snacks is central to treatment, and vitamin levels (particularly the fat-soluble vitamins A, D, E and K) are monitored and corrected if low. See our "Nutrition in Pancreatitis" leaflet for more detail.
If pain is related to a blocked or narrowed pancreatic duct, or duct stones, an endoscopic procedure (ERCP) can sometimes clear stones, dilate a stricture, or place a stent to improve drainage. Extracorporeal shockwave lithotripsy (ESWL) (using sound waves to fragment stones from outside the body) may also be used, often alongside endoscopy, particularly if surgery is not suitable.
For people with significant pain related to a blocked, dilated pancreatic duct, surgery is generally the recommended first-line treatment, and tends to give more durable pain relief than endoscopic treatment alone in this situation. The choice of operation depends on the pattern of disease:
Your surgical team will discuss which, if any, of these options is suitable for you, along with the expected benefits and risks specific to your situation.
Chronic pancreatitis is a lifelong condition, and the structural damage already present cannot be reversed. However, with the right combination of lifestyle change, symptom control, nutritional support and, where appropriate, endoscopic or surgical treatment, many people are able to manage their symptoms well and maintain a good quality of life. Pain can, for some people, ease over time as the pancreas becomes less active (sometimes called "burning out"), although this is not something that can be relied upon or predicted, and complications such as diabetes or enzyme deficiency can still develop or progress.
Because chronic pancreatitis affects digestion, blood sugar, bone health, pain, and sometimes mental wellbeing, ongoing follow-up with your specialist team (including regular blood tests, bone scans, and open conversations about pain and mood) is an important part of staying well. Please do raise any new or changing symptoms, and don't hesitate to ask for psychological support if the condition is affecting your mood or daily life; this is a common and understandable part of living with a chronic illness, not a sign of weakness.
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In an emergency, call 999. For urgent health advice, call NHS 24 on 111.
