Pancreatitis: Acute and Chronic

Pancreatitis is the term used to describe inflammation of the pancreas. The pancreas is a gland that sits behind the stomach, and it carries out two essential jobs in the body. It produces digestive enzymes that travel through a system of ducts into the small intestine, where they help break down food. It also produces hormones, including insulin, which pass directly into the bloodstream to help control blood sugar levels. When the pancreas becomes inflamed, both of these jobs can be affected.

Pancreatitis is generally described in one of two ways. Acute pancreatitis develops suddenly and usually settles within a short period with the right care. Chronic pancreatitis develops slowly and causes lasting, permanent change to the pancreas over time. Understanding the difference between these two forms is an important first step in recognising symptoms and seeking appropriate care.

Acute Pancreatitis

Acute pancreatitis occurs when the pancreas becomes suddenly and severely inflamed. For most people, the inflammation settles within a week or two with appropriate hospital care. In a smaller number of cases, the condition becomes more serious and requires closer monitoring and more intensive treatment.

Causes of Acute Pancreatitis

Gallstones and heavy alcohol consumption are responsible for most cases of acute pancreatitis. Gallstones can trigger pancreatitis because the gallbladder and pancreas share the same drainage duct into the small intestine. If a gallstone becomes lodged in this duct, digestive enzymes can build up inside the pancreas rather than flowing through to the bowel, leading to inflammation. Less commonly, acute pancreatitis can also follow very high levels of fat (triglycerides) in the blood, certain medicines, viral infections, abdominal trauma, or a procedure such as an ERCP (Endoscopic Retrograde Cholangiopancreatography). In some people, no clear cause is ever found.

Symptoms of Acute Pancreatitis

The main symptom of acute pancreatitis is sudden, severe pain in the upper abdomen, which often spreads through to the back. The pain is usually constant and can feel worse after eating. Many people also experience nausea, vomiting, fever, a rapid heartbeat and sweating. Because these symptoms can resemble other serious conditions, including a heart attack or a perforated ulcer, anyone with sudden, severe abdominal pain should seek emergency medical attention rather than waiting to see if the pain settles on its own.

Diagnosis of Acute Pancreatitis

A diagnosis of acute pancreatitis is usually reached through a combination of a physical examination, blood tests that measure pancreatic enzyme levels, and imaging such as an abdominal ultrasound, CT scan or MRI. These tests help confirm the presence of inflammation and identify the underlying cause, particularly whether gallstones are involved. Most people with acute pancreatitis are admitted to hospital for monitoring and treatment.

Treatment of Acute Pancreatitis

Initial treatment focuses on resting the pancreas and managing pain while the inflammation settles. This typically involves fluids given through a drip, adequate pain relief, and a short period without food before eating is gradually reintroduced. If gallstones are the underlying cause, removal of the gallbladder is generally recommended once the patient has recovered from the acute episode, to help prevent further attacks. This surgical procedure, known as a cholecystectomy, is performed by a surgeon, and your gastroenterologist will help coordinate this referral as part of your ongoing care. Where alcohol has contributed to an episode, stopping alcohol intake completely is an essential part of treatment and of reducing the risk of future episodes.

Chronic Pancreatitis

Chronic pancreatitis is a long-term condition that develops when the pancreas experiences repeated or ongoing inflammation. Unlike acute pancreatitis, the damage caused by chronic pancreatitis is permanent. It tends to progress gradually over months or years, slowly affecting the pancreas’ ability to produce digestive enzymes and hormones.

Causes of Chronic Pancreatitis

Long-term heavy alcohol use is the most frequently identified cause of chronic pancreatitis. Smoking is also recognised as a significant contributing factor, and the combination of alcohol and smoking appears to increase risk further. Other less common causes include genetic conditions affecting the pancreas, autoimmune disease, in which the body’s immune system mistakenly attacks the pancreas, and blockages within the pancreatic duct caused by scarring or growths. Some patients who have experienced one or more episodes of acute pancreatitis go on to develop chronic pancreatitis, even after the original trigger has been addressed.

Symptoms of Chronic Pancreatitis

The most common symptom of chronic pancreatitis is ongoing or recurring pain in the upper abdomen, which often spreads to the back. The pain may be constant, or it may come and go in episodes with periods of relief in between. As the condition progresses and the pancreas produces fewer digestive enzymes, some people develop signs of poor digestion, including unintended weight loss and stools that appear oily, pale or float in the toilet. If a large portion of the pancreas becomes damaged, insulin production may also be affected, which can lead to diabetes. Some people with chronic pancreatitis have few or no symptoms in the early stages and are diagnosed when tests are carried out for another reason.

Diagnosis of Chronic Pancreatitis

Diagnosing chronic pancreatitis can be more complex than diagnosing the acute form, as there is no single test that confirms the condition on its own. Your gastroenterologist will generally combine your medical history with imaging such as a CT scan, MRI or MRCP, and in some cases an endoscopic ultrasound, to assess the structure of the pancreas and its ducts. A stool test that measures an enzyme called faecal elastase may also be used to assess how well the pancreas continues to produce digestive enzymes.

Managing Chronic Pancreatitis

Because the damage caused by chronic pancreatitis cannot be reversed, management focuses on relieving symptoms, supporting digestion and preventing further harm to the pancreas. Stopping alcohol intake completely is one of the most important steps, regardless of how much alcohol was originally involved, as the pancreas appears to have no safe threshold once it has been damaged. Quitting smoking is also strongly recommended. Pain is usually managed with a stepped approach to pain relief, and some patients benefit from referral to a dedicated pain management service. Where digestive enzyme production has fallen, enzyme replacement supplements taken with meals can help improve digestion and reduce symptoms such as oily stools and weight loss. If diabetes develops as a result of pancreatic damage, this is managed in partnership with your GP or an endocrinologist.

Many patients also benefit from individualised dietary guidance, so your gastroenterologist may suggest finding a suitably qualified dietitian (such as, through the Dietitians Australia Find a Dietitian directory).

Possible Complications of Pancreatitis

Both forms of pancreatitis carry a risk of complications. In severe acute pancreatitis, fluid filled collections called pseudocysts can form around the pancreas, and in serious cases, areas of pancreatic tissue can become permanently damaged. Chronic pancreatitis can lead to ongoing poor digestion, diabetes, and reduced bone strength over time. People with chronic pancreatitis also carry a higher lifetime risk of developing pancreatic cancer compared with the general population. This is why ongoing monitoring with your gastroenterologist matters, particularly if new symptoms develop or existing symptoms change.

The Role of Your Gastroenterologist

A gastroenterologist specialises in the diagnosis and non-surgical management of conditions affecting the digestive system, including the pancreas. For pancreatitis, this involves identifying the underlying cause, arranging and interpreting blood tests and imaging, and developing an appropriate ongoing management plan. Where further investigation of the pancreas or pancreatic duct is needed, procedures such as an endoscopic ultrasound or an ERCP are carried out by your gastroenterologist.

It is important to understand that some aspects of pancreatitis care sit outside the scope of gastroenterology. Removal of the gallbladder, and other surgical procedures such as the removal of damaged pancreatic tissue, are performed by a surgeon. If pancreatic cancer is suspected or confirmed, care will involve a multidisciplinary team that includes an oncologist. Your gastroenterologist works alongside these specialists, and alongside your GP, to coordinate appropriate care for your individual circumstances.

When to Seek Urgent Care

Sudden, severe abdominal pain should never be ignored. If you experience sudden pain in your upper abdomen, particularly if it spreads to your back and is accompanied by nausea, vomiting or fever, you should seek urgent medical attention at your nearest emergency department. Do not wait to see if the pain settles on its own.

Speak With Your GP

If you have ongoing abdominal pain, digestive symptoms, or concerns about your pancreas, the appropriate first step is to speak with your GP. Your GP can arrange initial investigations and, where appropriate, refer you to a gastroenterologist at Queensland Gastroenterology.

Our specialist team supports patients with pancreatitis across Brisbane and South East Queensland, from diagnosis through to long-term management. Once you have your referral, please contact our practice directly to arrange an appointment.

This information has been adapted from the following sources, as at 25/06/2026.

• Better Health Channel
• Health Direct Australia
• Turner, R. (2015). Chronic pancreatitis: Negotiating the complexities of diagnosis and management. Australian Family Physician, 44(10), 718–722. Retrieved from: https://www.racgp.org.au/afp/2015/october/chronic-pancreatitis-negotiating-the-complexities
• Dietitians Australia https://member.dietitiansaustralia.org.au/faapd