A sharp pain high in the abdomen that seems like “acidity” can sometimes have a much more serious source. When that pain becomes severe, persists or starts travelling to the back, the pancreas may be involved, according to Dr Pramod Garg, Professor and Head of Gastroenterology and Human Nutrition at AIIMS, New Delhi. Nausea and vomiting may accompany the pain, while fever, rapid heartbeat and breathing difficulty can occur in more severe cases.That distinction matters because acute pancreatitis can range from a mild illness to a life-threatening condition affecting multiple organs. Unlike ordinary indigestion, which more commonly causes bloating, belching, early fullness or a burning sensation, pancreatitis involves inflammation of the pancreas and can trigger a much wider inflammatory response.“The pancreas is a small but extremely important organ,” Dr Garg, President, Indian Society of Gastroenterology and Co-Chair, Steering Committee, WCOG 2026, explains that it sits behind the stomach and has two major jobs: producing digestive enzymes and hormones such as insulin that help regulate blood glucose.The trouble begins when digestive enzymes that are supposed to help break down food become prematurely activated inside the pancreas itself.“These very digestive enzymes when inappropriately become active within the pancreas cause havoc and lead to acute pancreatitis,” Dr Garg says.
India is seeing a growing pancreatitis burden
The condition is not a rare gastrointestinal problem. A 2025 analysis published in the Indian Journal of Gastroenterology, using Global Burden of Disease 2021 data, shared by Dr Garg, estimated that incident pancreatitis cases in India rose from 229,614 in 1990 to 523,074 in 2021.Acute pancreatitis can have several causes, but gallstones and alcohol are among the most common and established causes, he says. High triglyceride levels, certain medicines and trauma can also trigger the condition.Finding the cause is not merely about explaining why the illness happened. It can determine treatment and help prevent another episode.
Why can pancreatitis affect the lungs and kidneys?
The pancreas may be the starting point, but severe pancreatitis can become a disease involving the entire body.Dr Garg explains that premature enzyme activation, cellular stress and inflammatory signalling can cause pancreatic injury. In severe cases, the inflammatory response can become systemic and lead to dysfunction of organs far beyond the pancreas, including the lungs and kidneys.His research at AIIMS has examined the mechanisms behind organ failure in severe acute pancreatitis.The intestine is also increasingly being recognised as part of this process. According to Dr Garg, acute pancreatitis can be associated with a defective intestinal barrier, while research into the gut microbiome and its role in pancreatitis is also emerging.This helps explain why severe pancreatitis can become so complicated. It is not simply a swollen pancreas. The illness can involve an intricate interaction between the pancreas, immune system, intestine and other organs.
How doctors diagnose acute pancreatitis
Doctors generally diagnose acute pancreatitis using a combination of symptoms, blood tests and imaging, when required, says Dr Garg.An ultrasound can be particularly useful when doctors are looking for gallstones. CT scans play an important role in identifying and managing complications, while MRI may be used selectively depending on the clinical situation.The distinction from indigestion is therefore not something a person should try to make based solely on symptoms at home.
Treatment is not simply about controlling pain
Treatment for acute pancreatitis has evolved significantly, Dr Garg says. Management can include carefully guided fluid therapy, pain relief, early nutritional support and close monitoring for organ dysfunction.Importantly, early oral feeding is now supported when patients can tolerate it, rather than automatically keeping every patient without food for prolonged periods.People with severe disease may require intensive care. Complications can include secondary bacterial infections, which may require antibiotics and procedures such as endoscopic treatment and, in some cases, surgery.Dr Garg also points to another growing challenge: multidrug-resistant bacterial infections, which can be difficult to treat. He stresses the importance of judicious antibiotic use to limit antibiotic resistance.
Recovery does not always mean the story is over
Even after the acute episode settles, some patients can develop longer-term complications.Dr Garg notes that diabetes can develop in up to one-third of patients after pancreatitis, making follow-up and periodic monitoring important.Preventing another episode also depends heavily on its cause. For people whose pancreatitis is linked to alcohol, abstinence is important. Smoking cessation is also crucial because smoking can contribute to recurrence and chronic pancreatitis.When gallstones are responsible, removal of the gallbladder, or cholecystectomy, is recommended to reduce the risk of recurrent pancreatitis, he says.The condition and its evolving treatment will be among the scientific issues discussed at the World Congress of Gastroenterology 2026 in New Delhi, hosted by the World Gastroenterology Organisation and the Indian Society of Gastroenterology.But for someone sitting at home with sudden abdominal pain, the most important message is much simpler. Prompt medical evaluation can help distinguish a routine digestive complaint from an illness that may require urgent treatment. As Dr Garg puts it, what appears to be indigestion “may sometimes have its origin in the pancreas.”
