Pancreatitis Treatment for Acute, Chronic, and Severe Cases
In pancreatitis, the pancreas — a gland located behind the stomach and near the first part of the small intestine — becomes inflamed. There are varying severities of the condition, but abdominal pain, nausea, and vomiting are among the most common symptoms of both acute and chronic pancreatitis.
Cases of moderate and severe acute pancreatitis are treated in the hospital. Visits should only last a few days. Doctors will administer blood and imaging tests to diagnose you, and then begin care.
Because of the loss of fluids from vomiting and decreased food intake, the initial treatment for pancreatitis is hydration using intravenous (IV) therapy with one of several different kinds of solutions.
Most often, patients will receive what’s called “aggressive hydration,” which may consist of 250 to 500 milliliters of fluid administered every hour. (1)
Research suggests that administering fluids through IV in the first few hours of onset can help prevent acute pancreatitis from turning into severe pancreatitis. (2)
Aggressive intravenous therapy appears to be most beneficial during the first 12 to 24 hours of treatment, according to the American College of Gastroenterology, but may not help much after this. (3)
After a few days, you may be allowed to begin eating solid, bland foods. But if eating causes too much pain, you may be given nutrients through a feeding tube that’s inserted through your nose and reaches down to your stomach.
There is no medication to stop the chemical chain reaction in the pancreas that’s causing the pain. But drugs are sometimes prescribed to help alleviate that pain. Doctors may use opioids, such as morphine and fentanyl.
Once the pain has subsided and your fluids and other vital signs have stabilized, you will be allowed to go home.
There is no cure for chronic pancreatitis, but the related pain and symptoms may be managed or even prevented. Since chronic pancreatitis is most often caused by drinking, abstinence from alcohol is often one way to ease the pain.
The following drugs are prescribed for pain relief:
Chronic pancreatitis typically results in malabsorption, the body’s inability to process important nutrients. So your doctor may prescribe vitamins and medication that may help in digestion.
Surgery may help relieve the chronic pain of this condition, but not always.
Doctors aren’t sure why the pain in chronic pancreatitis is so severe. More recent theories posit that the inflamed nerves of the pancreas stimulate the pain signaling system of the spine in a way that increases sensitivity to and frequency of pain. ( 4)
It’s long been thought that an inflamed head of the pancreas or a blocked pancreatic duct causes the pain. In cases where doctors believe that to be the problem, surgery will be performed to remove the head of the pancreas. If a blocked pancreatic duct is suspected to be the issue, endoscopic treatments to remove the blockages will be performed.
There is also a surgery performed on those whose pain will not respond to treatment. During this procedure, known as autologous islet cell transplantation, the entire pancreas is removed and the insulin-making cells of the pancreas are reinserted into the liver with a catheter.
When the transplant is successful, it allows patients to make insulin without the pancreas.
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About 20 percent of pancreatitis cases are severe, meaning they result in multiple organ failure that doesn’t naturally subside within 48 hours. (3)
People with severe pancreatitis may need to be transferred to an intensive care unit for extended treatment, which could last more than a week.
Due to vomiting, sweating, and reduced consumption of food and liquids, severe pancreatitis frequently causes hypovolemia — a decreased volume of blood circulating in the body.
One of the most common complications of severe pancreatitis is an infection of necrotic tissue in the pancreas, or tissue that has died due to a lack of blood supply. These infections are treated with antibiotics. The dead or damaged tissue may need to be removed surgically.
While some research suggested there may be benefits, the consensus among experts is that probiotics do not appear to reduce the risk of infectious complications in severe pancreatitis. (5)
People with severe pancreatitis may require several weeks of nasogastric feeding, in which a feeding tube carries food to the stomach through the nose.
Antibiotics may also be necessary if an extra-pancreatic (outside of the pancreas) infection has developed.
Up to one-third of people with pancreatitis develop an extra-pancreatic infection, according to a 2014 report. (6) Extra-pancreatic infections can range from urinary tract infections to pneumonia.
Gallstones are the number one cause of acute pancreatitis. For the majority of these cases, the gallstones are small and don’t remain in the bile duct or pancreatic duct for long.
But sometimes the obstruction doesn’t go away without treatment, and doctors need to remove it using a procedure called endoscopic retrograde cholangiopancreatography (ERCP).
If gallstones are found in the gallbladder, the gallbladder may need to be removed via surgery to prevent the recurrence of pancreatitis after treatment.
In addition to hospital treatment, the following lifestyle changes are recommended to help aid recovery and possibly prevent pancreatitis:
There is no one specific pancreatic diet that can treat chronic pancreatitis.
But there are some general rules for nutrition if you have the condition. It’s extremely important to avoid alcohol, for example, as well as high-fat foods, because they will tax an already overworked pancreas.
The National Institutes of Health says that pancreatitis patients should consume no more than 30 grams of fat a day. (7)
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Additional reporting by Carlene Bauer.
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