Acute pancreatitis at the beginning of the 21st century: The state of the art

Abstract

Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome with significant morbidity and mortality in 20% of patients. Gallstones and alcohol consumption are the most frequent causes of pancreatitis in adults. The treatment of mild acute pancreatitis is conservative and supportive; however severe episodes characterized by necrosis of the pancreatic tissue may require surgical intervention. Advanced understanding of the pathology, and increased interest in assessment of disease severity are the cornerstones of future management strategies of this complex and heterogeneous disease in the 21st century.

Cardiocirculatory pathophysiological mechanisms in severe acute pancreatitis

“…It is related to organ or multiorgan failure, secondary to SIRS, and is not necessarily related to the presence of pan creatic necrosis [8] . The late phase, starts 14 d after the onset of the disease and is marked by infected necrosis of the gland, septic systemic complications and multiorgan failure syndrome, causing a significant increase in mortality [9,10] . Reports from various countries have shown an increase in AP incidence [11,12] , perhaps in relation to rising obesity rates, which would increase the development of gallstone pancreatitis [13] .…”

“…Reports from various countries have shown an increase in AP incidence [11,12] , perhaps in relation to rising obesity rates, which would increase the development of gallstone pancreatitis [13] . Moreover, although fatalities associated with AP have decreased over time, the population mortality rate has remained unchanged [10,14] . The lack of advances in the management of AP reflects both the limited understanding of the early AP pathophysiological mechanisms and the difficulty in identifying the patients who are at risk of developing severe disease [3,10] .…”

“…Moreover, although fatalities associated with AP have decreased over time, the population mortality rate has remained unchanged [10,14] . The lack of advances in the management of AP reflects both the limited understanding of the early AP pathophysiological mechanisms and the difficulty in identifying the patients who are at risk of developing severe disease [3,10] . Accurate diagnosis of SAP on admission to the hospital is of paramount importance [15] and there is, therefore, agreement about the need for finding predictors of severe disease to identify patients who are at risk of morbidity and death.…”

Does presence of common bile duct stones in patients with acute biliary pancreatitis affect the severity of illness or laboratory findings?

“…On the other hand, the frequency of persistent CBD stones in patients with ABP was reported to range between 10%-72% depending on the timing of cholangiography (5,6,7,9). The presence of CBD stones also affects the treatment method (2)(3)(4). Although there remains some controversy, persistence of stones in the bile duct or ampulla was claimed to be associated with more severe pancreatitis (8)(9)(10).…”

“…Gallstone pancreatitis, in most cases, is caused by gallstones passing into the bile duct (2). Screening methods often fail to detect the presence of common bile duct (CBD) stones in patients with acute biliary pancreatitis (ABP).…”