Pancreatitis is a condition where the pancreas becomes inflamed. The pancreas is an organ located behind the stomach that produces enzymes that help digest food and hormones like insulin that regulate blood sugar levels. There are two main types of pancreatitis:
Acute Pancreatitis
Acute pancreatitis involves sudden inflammation of the pancreas that develops quickly and lasts for a short amount of time. An episode of acute pancreatitis typically resolves within a few days with proper treatment. Common causes include:
- Gallstones
- Heavy alcohol use
- High triglyceride levels
- Certain medications
- Infections
- Trauma or surgery involving the pancreas
In mild cases, the pancreas may only become slightly swollen and inflamed. In severe cases, there may be necrosis (death) of pancreatic tissue. Acute pancreatitis often comes on suddenly and causes severe abdominal pain along with nausea, vomiting, fever, and an elevated heart rate.
The inflammation from acute pancreatitis usually goes away in a few days but sometimes takes a week or two to fully resolve. Mild cases may resolve on their own with rest and fluids. Severe cases often require hospitalization for supportive care like pain management, IV fluids, and nutrition.
Chronic Pancreatitis
Chronic pancreatitis involves long-term inflammation of the pancreas that doesn’t improve and may progressively worsen over time. Potential causes include:
- Repeated episodes of acute pancreatitis
- Heavy alcohol use over many years
- Genetic factors
- Cystic fibrosis
- Autoimmune disease
- Blockage of a pancreatic duct
Chronic pancreatitis causes persistent dull abdominal pain along with diarrhea, unintentional weight loss, and oily stools. The condition leads to permanent scarring and damage to the pancreas over time. This can impair its ability to produce digestive enzymes and insulin.
Can Pancreatitis Come and Go?
For acute pancreatitis, the inflammation and symptoms typically come on suddenly and then resolve within days or weeks as the pancreas recovers. It is possible for acute pancreatitis to recur or for someone to experience multiple episodes throughout their lifetime.
With chronic pancreatitis, the inflammation is continuous but may periodically flare up. A flare-up causes worsening of pain and other symptoms. There may be periods where the inflammation smolders at a low level with minimal symptoms in between acute flare-ups. Over time, the damage from chronic pancreatitis is cumulative and symptoms tend to progressively worsen.
So in summary:
- Acute pancreatitis is a temporary condition that comes on suddenly then resolves.
- Chronic pancreatitis involves ongoing inflammation that may have periodic flare-ups.
- It is possible for pancreatitis to come and go, especially earlier in the disease process.
- As chronic pancreatitis advances, periods of remission become less likely.
Why Does Pancreatitis Flare Up?
There are a few potential reasons why someone with chronic pancreatitis may experience periodic flare-ups of their symptoms:
- Dietary triggers – Eating large, high-fat meals may trigger inflammation. Alcohol use can also flare up pancreatitis.
- Medications – Some prescription drugs are associated with pancreatitis flares.
- Infections – Viral or bacterial infections can inflame the pancreas.
- Stones – Gallstonespassing through the common bile duct can obstruct pancreatic enzymes.
- Unknown reasons – In some cases, flare-ups occur spontaneously without an identifiable cause.
Acute pancreatitis may recur for similar reasons. An attack of acute pancreatitis can increase the risk of developing chronic pancreatitis down the line.
Symptoms of a Pancreatitis Flare-Up
Signs that pancreatitis is flaring up again include:
- Severe upper abdominal pain that may radiate to the back
- Nausea and vomiting
- Fever
- Rapid heart rate
- Tenderness of the abdomen
- Diarrhea
- Greasy stools that are foul smelling
- Unexplained weight loss
- Loss of appetite
The pain is often described as a dull, constant ache that worsens after eating. The abdominal pain may be very severe and unrelenting during a flare-up.
Diagnosing a Pancreatitis Flare
If chronic pancreatitis symptoms flare up again, the doctor will try to determine if there is a new attack of acute pancreatitis or if it is a exacerbation of the underlying chronic condition. Tests may include:
- Physical exam – Tenderness when pressing on the abdomen may indicate pancreatitis.
- Blood tests – Levels of pancreatic enzymes like amylase and lipase may be elevated during an attack.
- Imaging – CT scan, MRI, or ultrasound to look for inflammation of the pancreas.
- Stool test – Checking for high fat content which can occur with pancreatitis.
The doctor will also try to identify any trigger that may have caused the flare-up, such as changes to medications, diet, alcohol use, recent infections, or abdominal trauma.
Treating a Pancreatitis Flare
Treatment of a flare-up involves relieving symptoms and limiting any further damage to the pancreas. Steps usually include:
- Resting the pancreas by not eating or drinking for a short time
- IV fluids to prevent dehydration
- Strong pain medications
- Antiemetic drugs for nausea and vomiting
- Antibiotics if there is an infection of the pancreas
- Nutritional support through an IV or feeding tube if needed
For mild flare-ups, the symptoms may resolve within a few days with oral rehydration and rest. Severe attacks may require hospitalization.
Preventing Future Pancreatitis Flare-Ups
Steps that may help reduce the likelihood of additional attacks include:
- Following a low-fat diet and eating smaller, more frequent meals
- Completely avoiding alcohol
- Taking pancreatic enzyme supplements
- Using medications to help manage pain
- Working with your doctor to optimize any medications that can cause pancreatitis
- Quitting smoking
- Getting treatment for any underlying conditions linked to pancreatitis flares
Even with preventive measures, flare-ups may still occur in some cases of chronic pancreatitis. Working closely with your doctor is important to manage any attacks quickly and limit the impacts.
Long-Term Outlook for Recurrent Pancreatitis
For people with chronic pancreatitis, the long-term outlook depends on the extent of damage to the pancreas and how well prevention measures can reduce attacks. Potential complications include:
- Malnutrition – Difficulty digesting fats and proteins may lead to deficiencies.
- Diabetes – Loss of insulin-producing beta cells may result in diabetes.
- Pancreatic cancer – Long-standing inflammation increases this risk.
- Narcotic addiction – Due to reliance on pain medications.
Early treatment to preserve pancreas function and prevent flare-ups is important. Those who develop chronic pancreatitis from alcohol abuse have a better outlook if they stop drinking completely.
For acute pancreatitis, the long-term outlook is generally good if the underlying cause is properly addressed. But recurrent acute attacks can increase the eventual risk of developing chronic pancreatitis.
When to See a Doctor
See your doctor promptly if you experience potential signs of a pancreatitis flare, such as:
- Severe and persistent abdominal pain, especially after eating
- Nausea and vomiting
- Fever higher than 100°F (37.8°C)
- Greasy stools
- Unexplained weight loss
Seek emergency care for abdominal pain that reaches a level you cannot bear. Acute pancreatitis can quickly become life-threatening without rapid treatment.
Call your doctor right away if you have a history of pancreatitis and suddenly develop worsening symptoms that could signal a flare-up. Prompt treatment of recurrences may help minimize any added damage to your pancreas.
Conclusion
Pancreatitis involves inflammation of the pancreas that impairs its function. Acute pancreatitis usually resolves completely within days or weeks. Chronic pancreatitis causes persistent inflammation that may have periodic flare-ups between times when symptoms smolder at a lower level.
Both acute and chronic pancreatitis can come and go over time. But chronic pancreatitis tends to worsen gradually. Preventing recurrences and treating them quickly aims to limit as much permanent damage to the pancreas as possible.
Seeking prompt medical care for any symptoms of a pancreatitis flare-up is important. Working closely with your doctor can help reduce episodes through preventive steps and better control of this difficult disorder.