Acute pancreatitis

This review presents advances in our understanding of the pathobiologic responses that mediate acute pancreatitis with an emphasis on the interrelationship between the events occurring in the pancreatic acinar cell and the vascular, neural, and immune systems; information on recent reports describing clinical diagnostic and therapeutic aspects of autoimmune pancreatitis; and information on feeding strategies during acute pancreatitis.

The reports during the past year provide important and clinically relevant findings about roles of intracellular events as well as vascular and neural regulatory pathways involved in the mechanism of pancreatitis. Reports during the past year also add to our rapidly growing portfolio describing the characteristics, course, and therapeutic responses in autoimmune pancreatitis. Finally, a provocative report demonstrates that a low-fat elemental-like diet administered by nasogastric tube during severe pancreatitis does not worsen outcome compared with administration of the diet by nasojejunal tube. This report provides rationale for early feeding in these patients by a simpler route than previously recommended and also raises the question about the types of nutrients that should be used in this situation that have the least effect on neurohumoral stimulation of the pancreas.

Our understanding of the mechanistic processes that mediate the pathobiologic responses of pancreatitis is rapidly evolving. The continuing challenge is to translate these findings into treatment strategies for pancreatitis.