GPAtlas🧭 When to suspect
Chronic pancreatitis is progressive, irreversible inflammation of the pancreas, leading to fibrosis and the gradual loss of both exocrine (digestive enzyme) and endocrine (insulin) function. Unlike acute pancreatitis it is a long-game disease, and by the time a GP sees it the gland is often already scarred.
This guideline assumes the person has usually already been investigated for upper abdominal pain with ultrasound, CT, or upper GI endoscopy; the role of primary care is to think of the diagnosis and refer, since confirmation rests on specialist imaging (CT, MRI/MRCP ± endoscopic ultrasound).
Suspect it in anyone with chronic or recurrent upper abdominal pain – classically dull, deep, epigastric pain radiating to the back, often eased by sitting forward and provoked by eating (especially fatty food). Pain is absent in around 20% of people, whatever the cause. The history frequently includes recurrent acute pancreatitis, chronic heavy alcohol use, or smoking. Later features of pancreatic insufficiency – steatorrhoea (pale, oily, hard-to-flush stools), weight loss, or new-onset diabetes – point to an advancing or burnt-out gland, and should always prompt the question of underlying malignancy.
It is most useful to hold the condition in mind as three failures of one gland, each of which needs separate attention:
| Problem | How it shows | Primary-care marker |
|---|---|---|
| Pain | Recurrent/constant epigastric pain radiating to the back | History; stepwise analgesia and pain-team input |
| Exocrine failure | Steatorrhoea, weight loss, fat-soluble vitamin deficiency | Faecal elastase-1 (< 200 µg/g) |
| Endocrine failure | Thirst, polyuria, weight loss (Type 3c diabetes) | HbA1c (check at least 6-monthly) |
Source: NICE NG104
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