What is the difference between acute and chronic pancreatitis?

Pancreatitis is an inflammation of the pancreas, a large gland located behind the stomach that secretes digestive juices and hormones such as insulin and glucagon. Pancreatitis can be acute or chronic, and both are serious conditions that may lead to complications [1].

Acute Pancreatitis

Acute pancreatitis occurs suddenly and usually resolves within a few days with treatment. Gallstones are often the most common cause [1]. Other causes include excessive alcohol consumption, high levels of triglycerides in the blood (usually above 1000 mg/dL), certain medications, specific infections like mumps, as well as some diagnostic procedures such as Endoscopic Retrograde Cholangiopancreatography (ERCP) [2]. It can affect men more than women [2].

Symptoms: Acute pancreatitis is characterized by severe pain in the upper left or middle abdomen, which may worsen after eating, especially foods rich in fat. The pain can become constant and severe, lasting for several days, and may radiate to the back or below the left shoulder blade. Other symptoms include nausea, vomiting, fever, sweating, and abdominal bloating [2].

Treatment: Treatment usually requires hospitalization to receive intravenous fluids and pain relievers. Management may also include avoiding oral food and drink for a period to reduce pancreatic activity, with the potential use of a feeding tube if necessary. In some cases, procedures may be required to remove gallstones or relieve obstructions [2].

Chronic Pancreatitis

Unlike acute pancreatitis, chronic pancreatitis does not heal or improve over time; instead, it worsens and leads to permanent damage to the pancreas [1]. The most common cause is long-term excessive alcohol use, as consuming about 4 to 5 drinks daily for 5 years or more can lead to pancreatic damage [2]. Other causes include cystic fibrosis, certain genetic disorders, high levels of calcium or lipids in the blood, certain medications, and autoimmune diseases [1].

Symptoms: Symptoms of chronic pancreatitis include nausea, vomiting, weight loss, and fatty stools [1]. Abdominal pain may also be a hallmark feature, and complications such as diabetes or malabsorption may develop due to permanent pancreatic damage.

Treatment: Treatment aims to manage symptoms and prevent complications. This may include hospitalization for intravenous fluids, pain relievers, and nutritional support. Subsequently, the patient may need to take pancreatic enzyme replacements and follow a special diet. It is very important to quit smoking and avoid alcohol [1].

Prevention and Follow-up

To reduce the risk of new or recurrent episodes of pancreatitis, alcohol should be avoided if it is the suspected cause of the acute episode, and smoking should be quit, as it can worsen both acute and chronic pancreatitis. It is also advised to manage medical issues that lead to high blood triglyceride levels and to follow a low-fat diet after consulting with a nutritionist [2]. For more information on managing chronic pancreatitis, you can visit Chronic Pancreatitis: Pain Management, Diet, and Preventing Complications (Arabic).

When to Seek Emergency Care

You should contact a doctor immediately or seek emergency care if you experience severe and persistent abdominal pain, or if you develop other symptoms of acute pancreatitis such as fever, nausea, and severe vomiting [2]. These symptoms may indicate a worsening condition and require urgent medical intervention.

Medical references

• Pancreatitis
• Acute pancreatitis
• Endoscopic Retrograde Cholangiopancreatography (ERCP)