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Diagnosis and Management of Acute Pancreatitis
Guru Trikudanathan1, Cemal Yazici2, Anna Evans Phillips3
1Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota.
Insights
Acute pancreatitis (AP) management has significantly evolved, emphasizing early feeding and minimally invasive techniques. Current standards of care now avoid certain interventions and focus on preventing recurrence and long-term complications like diabetes.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Acute pancreatitis (AP) incidence is rising globally across all age groups.
- Significant advancements in AP management have emerged over the last decade.
Purpose of the Study:
- To provide an update on critical changes in the management of acute pancreatitis.
- To highlight evolving standards of care for this increasingly prevalent condition.
Main Methods:
- Review of recent literature and clinical guidelines.
- Synthesis of updated management strategies for acute pancreatitis.
Main Results:
- Current standard of care includes avoiding total parenteral nutrition and prophylactic antibiotics.
- Early feeding, same-admission cholecystectomy, and minimally invasive approaches for infected necrosis are recommended.
- Emphasis on recognizing and managing risks of AP recurrence, progression to chronic pancreatitis, diabetes, and exocrine insufficiency.
Conclusions:
- Updated management strategies aim to improve outcomes and reduce complications associated with acute pancreatitis.
- Ongoing research focuses on the long-term sequelae of AP, including metabolic and digestive insufficiency.
Abstract:
Acute pancreatitis (AP) is increasing in incidence across the world, and in all age groups. Major changes in management have occurred in the last decade. Avoiding total parenteral nutrition and prophylactic antibiotics, avoiding overly aggressive fluid resuscitation, initiating early feeding, avoiding endoscopic retrograde cholangiopancreatography in the absence of concomitant cholangitis, same-admission cholecystectomy, and minimally invasive approaches to infected necrosis should now be standard of care. Increasing recognition of the risk of recurrence of AP, and progression to chronic pancreatitis, along with the unexpectedly high risk of diabetes and exocrine insufficiency after AP is the subject of large ongoing studies. In this review, we provide an update on important changes in management for this increasingly common disease.
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