Treatment

Acute Pancreatitis

Treatment is largely supportive with provision of analgesia, intravenous fluids, nutritional support and treatment of any potential complications such as infection. Severe cases are admitted to intensive care for close monitoring and to treat pulmonary, cardiovascular and kidney failure, if they develop.

In more severe cases later complications may occur after about two weeks. These include abscess formation in the pancreas and collections of fluid around the pancreas, known as pseudo-cysts. These complications may be associated with severe infection and bleeding, and require surgical treatment including drainage.

In the recovery phase it is important to try to identify the cause of acute pancreatitis. When it is due to alcohol excess people may need education and treatment to avoid further problems. If gallstones are found to be the cause, surgical removal of the gall stones or the gall bladder (cholecystectomy) is undertaken once the acute illness has resolved. (See Gallstones guidance).

Chronic pancreatitis

The aims of treatment are to prevent further attacks, relieve symptoms and minimise complications,

It is very important that people with chronic pancreatitis abstain from alcohol to prevent further damage to the gland. They may be referred to specialist services for advice and treatment of alcohol misuse.

A balanced diet with low fat and protein, and high carbohydrate is advised.

Abdominal pain is treated routinely with analgesics such as paracetamol and co-codamol. Exacerbations of pain lasting a few days are treated with increased fluids, restricted food intake and stronger analgesics. Some people may be admitted to hospital for a few days to treat a particularly severe episode.

Moderately strong analgesics (e.g. dihydrocodeine, tramadol, buphrenorphine) may be taken regularly and in high doses to control pain. Some may require intermittent or regular use of potent agents such as pethidine, fentanyl and morphine. These may be taken orally, by patches and sometimes by injection. Other drugs such as antidpressants (e.g. amitriptyline) which have pain-relieving properties may be added into the drug regime.

In some cases the abdominal pain of chronic pancreatitis may be so severe and frequent, that prescription of increasingly potent analgesics is needed. The person may become dependent on or addicted to potent opiate analgesics such as pethidine and morphine. It may be difficult for the medical attendant to discern whether increasing doses of these drugs are needed to control pain or to meet the dependency, and how to treat the person’s pain effectively in these circumstances.

People with increasing pain that does not respond to standard analgesic regimes, or those with intractable pain, are likely to be referred to specialist pain management clinics. Nerve blocks to the pancreas may be helpful.

In a minority of cases surgery to the pancreas to improve drainage of the pancreatic juices or to remove diseased tissue is undertaken to aid symptom relief.

Supplements are often prescribed to replace the pancreatic enzymes necessary for adequate digestion in the gut. This relieves the diarrhoea and steatorrhoea and reverses weight loss due to mal absorption. In some cases it is also thought to help the abdominal pain. Formulations containing the required enzymes are marketed under the names of Creon, Pancrex V. as capsules or powders. Up to 6 – 8 capsules have to taken at each mealtime and before bed to control the condition.

When pancreatitis affects insulin production causing diabetes mellitus (1in 3 cases), this condition requires treatment with oral hypoglycaemic drugs and/or insulin injection. (See Diabetes Mellitus guidance).

Amended April 2008