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Current management of acute pancreatitis

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 473–483 (2005)Cite this article

Abstract

The incidence of acute pancreatitis varies considerably between regions and is estimated at 5–80 per 100,000 population. The mortality rate of acute edematous-interstitial pancreatitis is below 1%, whereas 10–24% of patients with severe acute pancreatitis die. The early prognostic factors that can be used to determine whether the clinical course is likely to be severe are three or more signs of organ failure according to the Ranson or Imrie scores, the presence of nonpancreatic complications, and the detection of pancreatic necrosis by imaging techniques. Elevated C-reactive protein levels above 130 mg/l can also predict a severe course of acute pancreatitis with high sensitivity. Although no causal treatment exists, replacing the dramatic fluid loss that takes place in the early disease phase is critical and determines the patient's prognosis. Adequate pain relief with opiates is another therapeutic priority. In patients with pancreatic necrosis, the high mortality rate between the third and fourth week after the initial episode is determined largely by the development of pancreatic infection, and can therefore be reduced by early antibiotic treatment. Early enteral nutrition for the treatment of acute pancreatitis has been shown to be superior and much more cost-effective than parenteral nutrition. Infected pancreatic necrosis or pancreatic abscess are two of the few remaining indications for open surgery in acute pancreatitis. Even when indicated, surgery is frequently delayed or even replaced by minimally invasive surgical techniques.

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Figure 1: Axial contrast-enhanced CT scans of acute pancreatitis.
Figure 2: Meta-analysis of studies comparing enteral nutrition with parenteral nutrition in severe acute pancreatitis.
Figure 3: Algorithm for the management of acute pancreatitis at the University Hospital of Greifswald.

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Acknowledgements

The authors thank N Hosten and the Department of Diagnostic Radiology, Ernst-Moritz-Arndt University, Greifswald, Germany, for their assistance in preparing Figure 1.

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Authors and Affiliations

  1. senior registrar Department of Gastroenterology, Endocrinology and Nutrition, Klinik für Innere Medizin A, Ernst-Moritz-Arndt Universität Greifswald, Greifswald, Germany

    Julia Mayerle

  2. Professor and Chair of the Department of Gastroenterology, Endocrinology and Nutrition, Klinik für Innere Medizin A, Ernst-Moritz-Arndt Universität Greifswald, Greifswald, Germany

    Markus M Lerch

  3. registrar in the Department of Medicine B, Westfälische-Wilhelms-Universität Münster, Münster, Germany

    Verena Hlouschek

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Correspondence to Markus M Lerch.

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Mayerle, J., Hlouschek, V. & Lerch, M. Current management of acute pancreatitis. Nat Rev Gastroenterol Hepatol 2, 473–483 (2005). https://doi.org/10.1038/ncpgasthep0293

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