Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 8 Sept 2026Clinical review pending
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Escalate
A marked change in established pancreatic pain, new jaundice, gastrointestinal bleeding, sepsis or persistent vomiting requires fresh assessment for a complication or another diagnosis.
Synopsis
Recognise chronic pancreatic disease as a cause of pain and malnutrition, investigate its cause and complications, and coordinate nutritional, ductal, metabolic and functional care.
Chronic pancreatitis can impair digestion and endocrine function as well as cause pain. In stable adult care, review nutrition at least annually, HbA1c at least six-monthly and bone density every two years.
Alcohol and smoking are relevant exposures, but assess genetic, autoimmune, metabolic and structural causes without assumptions.
CT identifies calcification and advanced structural change; normal MRI does not exclude mild disease when clinical suspicion remains.
Key red flags
New obstructive jaundice, a focal pancreatic lesion or unexplained progressive weight loss.
Escalating pain with fever, persistent vomiting or signs of an acute abdomen.
Confusion, dehydration or symptomatic glucose disturbance in a patient with pancreatic diabetes.
New cancer or local complication concern
Progressive jaundice, a pancreatic mass, a new pain pattern or otherwise unexplained deterioration should prompt specialist investigation. Chronic pancreatitis can make imaging and tissue interpretation difficult, so an initially non-diagnostic sample does not automatically settle a concerning lesion. Pseudocyst, duct obstruction and vascular complications can also account for new symptoms and require their own treatment decisions.
Investigation priorities
01
Pancreatic structural imagingFirst step
Look for calcification, ductal abnormalities, atrophy, stones, complications and a possible mass.
Management branches
Worked caseWeight loss behind apparently quieter disease
A 59-year-old man with calcific chronic pancreatitis reports fewer painful attacks but has lost 6 kg in four months and stopped eating lunch because of oily stools.
CT shows established calcific disease without a new mass or biliary obstruction. He has a formed-stool elastase of 72 micrograms/g, reduced muscle bulk and inadequate intake. The team identifies pancreatic maldigestion and nutritional restriction as active problems despite improved pain, checks nutritional blood tests and glucose, and arranges specialist dietetic support.
He starts Creon 25,000 capsules at two with each main meal and one with each snack, spread through eating, with the formulation and safety counselling described below. The dietitian restores adequate energy and protein without a routine low-fat restriction. At four weeks his stools are less oily, he again eats lunch and his weight has increased by 1.4 kg; residual symptoms prompt a timing and dose review.
Key medicines
Creon 25,000 capsules (porcine pancreatin)For adult exocrine insufficiency, start 50,000 lipase units with a main meal (two capsules) and 25,000 with a snack (one capsule), distributed through eating. Increase gradually after checking response and administration. Swallow whole; if opened, take intact granules immediately with acidic soft food or fluid of pH below 5.5. Never chew or crush. Review additional causes when requirements exceed 100,000 units per meal or symptoms persist at 10,000 units/kg/day.Do not use with porcine-pancreatin or excipient hypersensitivity; stop and obtain urgent care for an allergic reaction. Maintain hydration and ensure no granules remain in the mouth. Assess new or unusual abdominal symptoms, especially at high doses: fibrosing colonopathy has been reported in cystic fibrosis, particularly above 10,000 lipase units/kg/day. Exercise caution with renal impairment, gout or hyperuricaemia; no routine renal or hepatic dose schedule is specified in this SmPC. Extreme overdose with raised urate needs enzyme withdrawal and rehydration. Pregnancy requires caution; breastfeeding is compatible, with doses sufficient for nutrition. The July 2026 product information advises immunosuppressed patients receiving high daily doses to seek medical attention for viral-hepatitis symptoms because possible porcine-source HEV transmission cannot be eliminated. Record product name and batch for traceability. No interaction studies have been performed. Store below 25°C, tightly closed, and use within six months after opening.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 8 Sept 2026; clinical approval remains outstanding.