Towards evidence-based and personalised care of acute pancreatitis

United European Gastroenterol J. 2020 May;8(4):403-409. doi: 10.1177/2050640620903225. Epub 2020 Jan 22.

Abstract

Acute pancreatitis is a heterogeneous illness. Most patients experience a mild course of disease, but one third will develop local complications and/or organ failure associated with increased morbidity and risk of mortality. Diagnosis of acute pancreatitis is based on typical epigastric pain, elevation of serum lipase or amylase levels, and/or characteristic findings on imaging. Personalised management is needed in patients with acute pancreatitis. Currently, analgesia, Ringer's lactate solution-based goal-directed fluid resuscitation and early oral refeeding providing enteral nutrition if not tolerated are the cornerstones for early management. Prophylactic antibiotics or endoscopic retrograde cholangiopancreatography in the absence of cholangitis are considered to be futile. Future clinical trials should address optimal fluid resuscitation, the early administration of anti-inflammatory drugs and the exact role of nutritional support in severe acute pancreatitis. Here, we present a patient case and review the diagnosis, treatment and prognosis of acute pancreatitis.

Keywords: Acute pancreatitis; Ringer’s lactate solution; amylase; antibiotics; enteral nutrition; revised Atlanta classification.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / immunology
  • Abdominal Pain / therapy
  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis / methods
  • Cholangiopancreatography, Endoscopic Retrograde
  • Enteral Nutrition / methods
  • Evidence-Based Medicine / methods*
  • Evidence-Based Medicine / trends
  • Fluid Therapy / methods
  • Gastroenterology / methods*
  • Gastroenterology / trends
  • Humans
  • Male
  • Middle Aged
  • Nausea / diagnosis
  • Nausea / immunology
  • Nausea / therapy
  • Pancreas / diagnostic imaging
  • Pancreas / immunology
  • Pancreas / surgery
  • Pancreatitis / complications
  • Pancreatitis / diagnosis
  • Pancreatitis / immunology
  • Pancreatitis / therapy*
  • Prognosis
  • Severity of Illness Index
  • Treatment Outcome
  • Vomiting / diagnosis
  • Vomiting / immunology
  • Vomiting / therapy

Substances

  • Anti-Bacterial Agents