Towards evidence‐based and personalised care of acute pancreatitis

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.

Pancreatogenic diabetes, acute pancreatitis management, and pancreatic tuberculosis: Appraising the present and setting goals for the future

“…Despite improved knowledge in the pathogenesis of the disease and increasing numbers of FDA approved drugs for less common conditions, there is still no proven effective disease-specific pharmacologic agent that alters the natural history of acute pancreatitis. 12 The current evidence in the early management of acute pancreatitis is reviewed in this issue of the journal by Garcia-Rayado et al 3 Early goal-directed fluid resuscitation with lactated Ringer's solution is the mainstay therapy of acute pancreatitis; however, either too little or too much volume can be harmful. The optimal volume, rate, and duration of intravenous fluid therapy is still unknown.…”

“…The current evidence in the early management of acute pancreatitis is reviewed in this issue of the journal by Garcia‐Rayado et al 3 Early goal‐directed fluid resuscitation with lactated Ringer’s solution is the mainstay therapy of acute pancreatitis; however, either too little or too much volume can be harmful. The optimal volume, rate, and duration of intravenous fluid therapy is still unknown.…”

“…This editorial will review three studies published in this issue of the United European Gastroenterology Journal, two of which focus on common inflammatory diseases of the pancreas and the third reviews one of the most common infectious diseases that rarely affect the pancreas. [2][3][4]…”

Drug discovery and formulation development for acute pancreatitis

“…The current medications usually failed due to the following problems. One is the blood pancreas barrier (BPB), which hinders the efficient drug delivery from the blood supply toward the inflammatory pancreas, and the other one is that single drug might not be sufficient to manage acute pancreatitis owing to a variety of complex pathologies (García-Rayado et al., 2020 ). Indeed, the complicated causes and pathologies make the clinic treatment of acute pancreatitis extremely difficult.…”

Early Weight-Based Aggressive vs. Non-Aggressive Goal-Directed Fluid Resuscitation in the Early Phase of Acute Pancreatitis: An Open-Label Multicenter Randomized Controlled Trial (The WATERFALL Trial), Design, and Rationale

“…Thus, a vital aim in the early management of AP is to decrease the incidence of moderate to severe disease. Unfortunately, there are currently no specific therapies for AP, so the cornerstone in the management of this frequent disease is supportive treatment, including fluid resuscitation, analgesia, and close monitoring for organ failure ( 3 ).…”