Current management and novel insights in acute pancreatitis

  title={Current management and novel insights in acute pancreatitis},
  author={Venkata Muddana and David C. Whitcomb and Georgios I. Papachristou},
  journal={Expert Review of Gastroenterology \& Hepatology},
  pages={435 - 444}
Acute pancreatitis (AP) is a common and potentially lethal acute inflammatory process. Approximately 10–20% of patients develop a severe course and suffer systemic inflammatory response and/or pancreatic necrosis (PNec). To date, there is no single biomarker proven to perform better than clinical judgment in predicting severe AP. The available prognostic clinical scoring systems are used primarily for research purposes. Management of AP is limited to supportive care and treatment of… 


Clinical management of acute pancreatitis is reviewed including the pathophysiology, diagnosis, and therapy excluding the nutritional aspect, which is important to correctly diagnose and manage appropriately.

Advancing the frontiers of clinical management in acute pancreatitis

This thesis demonstrates that enteral nutrition given via the nasogastric route is safe and well tolerated in most patients with acute pancreatitis, and indicates that use of a relatively inexpensive polymeric formulation is as safe and effective as a more costly elemental formulation.

The management of acute and chronic pancreatitis.

Treatment strategies for acute pancreatitis include fasting and short-term intravenous feeding, fluid therapy, and pain management with narcotics for severe pain or nonsteroidal anti-inflammatories for milder cases.

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The new premise of enteral feeding of dogs with acute pancreatitis early in the course of disease is supported, the sensitivity and specificity of two diagnostic tests are determined and an objective marker of disease severity is established.

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Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis.

Both the subcutaneous fasciotomy and ultrasound-guided drainage of intra-abdominal and/or peripancreatic fluid collections seem to be safe and effective alternatives in the management of abdominal compartment syndrome; however, prospective studies are needed to further evaluate their clinical role.

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Nutritional management in acute pancreatitis should aim primarily at maintaining the gastrointestinal function, and providing full nutritional requirements and avoiding pancreatic exocrine stimulation should be considered as secondary aims.

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The level of evidence for the major areas of management of acute pancreatitis in dogs is examined and the premise for early feeding is to improve the health of the intestinal tract, as unhealthy enterocytes are thought to perpetuate systemic inflammation.

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Given that APACHE II score is rather cumbersome, the combination of IAP and CRP appears to be the most practical way to predict critical course of AP early after hospital admission.

Early differential diagnosis of the severity of acute pancreatitis

The basal amplitudes of skin temperature oscillations in patients with AP were much lower than in healthy volunteers and progressively decreased as the disease severity increased, and the dysregulation of vascular tone during the contralateral cold test was observed in all patients withAP.



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Treatment of patients with acute pancreatitis is based on the initial assessment of disease severity and individual laboratory indexes (markers of pancreatic injury, markers of inflammatory response), while promising, have not yet gained clinical acceptance.

Chronic Alcohol Consumption Is a Major Risk Factor for Pancreatic Necrosis in Acute Pancreatitis

Chronic alcohol consumption seems to constitute a strong risk factor for PNEC, according to a series of preselected clinical factors in a prospectively collected cohort with AP.

Nutrition support in acute pancreatitis.

Enteral nutrition was cheaper, safer and more effective than total parenteral nutrition as regards the suppression of the immunoinflammatory response, the decrease of septic complications, the need for surgery for the management of the complications of acute pancreatitis and the reduction of the total hospitalization period.

Nutrition in the management of necrotizing pancreatitis.

Initial Management of Acute Pancreatitis: Critical Issues During the First 72 Hours

  • S. Tenner
  • Medicine
    American Journal of Gastroenterology
  • 2004
This review will focus on the early management of patients with acute pancreatitis in an attempt to prevent severe disease, complications, and death.

Natural history of acute pancreatitis and the role of infection.

  • R. IsenmannH. Beger
  • Medicine
    Bailliere's best practice & research. Clinical gastroenterology
  • 1999
Clinical and experimental data provide evidence that prophylactic antibiotics have beneficial effects on the outcome and course of patients with severe acute pancreatitis, but general recommendations concerning the early use of antibiotics have to await the results of larger, double-blind studies.

Early Endoscopic Intervention Versus Early Conservative Management in Patients With Acute Gallstone Pancreatitis and Biliopancreatic Obstruction: A Randomized Clinical Trial

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Patients with SAP and NOF have prolonged hospitalizations but low mortality and the Atlanta classification should be revised to include a patient group defined as “moderately severe acute pancreatitis” that identifies those patients currently classified as SAP without OF.

Early Antibiotic Treatment for Severe Acute Necrotizing Pancreatitis: A Randomized, Double-Blind, Placebo-Controlled Study

This study demonstrated no statistically significant difference between the treatment groups for pancreatic or peripancreatic infection, mortality, or requirement for surgical intervention, and did not support early prophylactic antimicrobial use in patients with severe acute necrotizing pancreatitis.