Acute pancreatitis: mechanisms and therapeutic approaches

Acute pancreatitis is a complex inflammatory condition characterized by sudden onset and rapid progression, with severe cases often associated with high mortality. In recent years, the global incidence of acute pancreatitis has been increasing, with marked regional differences. This increasing trend not only places a considerable burden on healthcare systems but also significantly affects the physical and psychological well-being of patients. The most common causes-gallstone disease, hypertriglyceridemia, and alcohol abuse-also vary by region. This review provides a structured summary of current knowledge regarding the definition and classification of acute pancreatitis, along with recent advances in clinical scoring systems, biomarkers, and predictive models based on artificial intelligence. These tools are particularly valuable for risk stratification and early clinical decision-making. In addition, this review discusses the multilevel pathophysiological mechanisms involved in acute pancreatitis, including aberrant enzymatic activation, calcium overload, impaired autophagy, inflammatory responses, and various forms of pancreatic acinar cell death. From a therapeutic perspective, both early-phase management and strategies for later disease stages are addressed. This review also briefly assesses adjunctive therapies rooted in traditional Chinese medicine, including bioactive monomers, compound herbal formulas, and external treatment modalities. Furthermore, attention is given to individualized treatment approaches for special populations, as well as to emerging therapeutic avenues such as nanotechnology and extracellular vesicle-based interventions. Together, these insights serve as a comprehensive reference for the diagnosis and management of acute pancreatitis while also suggesting potential directions for future research and innovation.