Chronic pancreatitis is lasting inflammation and scarring of the pancreas. It can cause pain, poor digestion of food and diabetes. Stopping alcohol and smoking, taking enzyme capsules correctly with meals, and looking after nutrition and bones make a real difference.

What is it?

In chronic pancreatitis, repeated or ongoing inflammation gradually replaces healthy pancreatic tissue with scar tissue. Over time the pancreas may make fewer digestive enzymes (exocrine insufficiency) and less insulin. The damage cannot be reversed, but its effects can be treated well.

Causes

• Long-term alcohol use
• Smoking, which adds to the risk on its own and with alcohol
• Repeated attacks of acute pancreatitis
• Inherited (genetic) changes, especially when it starts at a young age. A form called tropical pancreatitis, seen mainly in South Asia, also often starts young
• Blockage of the pancreatic duct, and autoimmune pancreatitis
• In some people no cause is found

Symptoms

• Pain in the upper abdomen, often going through to the back and worse after meals. It may be constant or come in attacks; some people have little or no pain
• Pale, oily, bulky stools that float or are hard to flush (steatorrhoea), with wind and bloating
• Weight loss and muscle loss despite eating
• Diabetes, which may appear years after the pancreatitis begins

Enzyme replacement and nutrition

If your pancreas does not make enough enzymes, pancreatic enzyme replacement capsules help you digest and absorb food. They are taken with every meal and snack that contains fat or protein:

• Take them with the first bites; with a long meal, take part at the start and part during the meal
• A typical starting dose is around 40,000 to 50,000 units of lipase with each main meal and about half that with snacks. The dose is then adjusted to your symptoms, stools and weight, and higher doses are often needed. The lipase units in each capsule are printed on the pack: for example, with 25,000-unit capsules, 50,000 units means two capsules
• Swallow the capsules whole; do not chew them. If you cannot swallow capsules, ask your pharmacist whether yours can be opened: if so, the granules can be mixed with a little cool, soft, acidic food such as apple purée or yoghurt and swallowed straight away without chewing. If they are not working well, your doctor may add an acid-reducing medicine
• Do not cut out fat: a normal diet with enough fat and protein, taken with the right enzyme dose, is better than a low-fat diet
• Vitamins A, D, E and K and bone density should be checked; thin bones are common, and calcium, vitamin D and bone treatment may be needed

Diabetes from pancreatitis

Diabetes caused by pancreatic damage (type 3c diabetes) behaves differently from the more common types. Tablets may help at first, but many people need insulin. Because the pancreas also makes less of the hormone that raises blood sugar, low sugar levels can be more sudden. Blood sugar or HbA1c should be checked at least yearly.

Pain and other treatments

• Stopping alcohol and smoking completely is the most important step; it can reduce pain and slow further damage
• Pain relief is built up in steps: paracetamol first, then other medicines, including some that calm nerve pain
• Strong opioid painkillers are used with caution and kept to the lowest effective dose. Escalating doses carry a risk of dependence and can make pain sensitivity worse over time
• If a stone or narrowing blocks the pancreatic duct, ERCP, shock-wave treatment to break stones, or surgery may help. Surgery can give longer-lasting relief for some people and is discussed by a specialist team

Common questions

This leaflet is general information and does not replace advice from your own doctor. Version 1.0, October 2026. Next review October 2028.