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Practice Guidelines

Pancreatitis: summary of NICE guidance

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3443 (Published 05 September 2018) Cite this as: BMJ 2018;362:k3443
  1. Eleanor Samarasekera, senior research fellow1,
  2. Shama Mahammed, health economist1,
  3. Sophie Carlisle, senior research fellow1,
  4. Richard Charnley, consultant hepatobiliary and pancreatic surgeon, guideline chair2
  5. on behalf of the Guideline Committee
  1. 1National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Department of Hepato-Pancreato-Biliary Surgery, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK
  1. Correspondence to: Richard Charnley Richard.Charnley{at}nuth.nhs.uk

What you need to know

  • Do not make people with acute pancreatitis “nil by mouth” and do not withhold food without clear reason

  • Consider chronic pancreatitis as a potential diagnosis in patients with recurrent or chronic abdominal pain

  • The long term use of opioids for pain management in chronic pancreatitis may cause harm; seek advice from specialist pain teams when managing uncontrolled pain in people with chronic pancreatitis

  • Type 3c diabetes is diabetes secondary to pancreatic disease, such as inflammation, and usually requires management in secondary care with ongoing support in the community

  • Offer HbA1c testing at least every 6 months and bone mineral density assessments every 2 years to people with chronic pancreatitis

Pancreatitis can severely reduce quality of life and may reduce life expectancy.12 Acute and chronic pancreatitis are characterised by inflammation of the pancreas, and table 1 outlines their features. Acute pancreatitis can recur if the cause is not identified and addressed. Over time, such patients may develop chronic pancreatitis. In its early stages this is characterised by acute exacerbations but also chronic pain, along with exocrine insufficiency, associated with fat malabsorption and malnutrition. Diabetes is also common. As chronic pancreatitis progresses, patients tend to experience fewer exacerbations but more chronic pain.

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Table 1

Features of acute and chronic pancreatitis

Specialists almost always manage acute pancreatitis because it is an acute abdominal emergency requiring hospital admission. However, non-specialists, including those in primary care, may be the first clinicians to identify chronic pancreatitis. Non-specialists may also manage and monitor symptoms including pain, endocrine and exocrine insufficiency, and make appropriate referrals.

Interventions used for management of acute pancreatitis show wide variation.3 Advice on management is often conflicting, and some patients have had difficulty accessing appropriate care. The new national guideline from the National Institute for Health and Care Excellence (NICE) on pancreatitis aims …

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