Current conservative treatment of acute pancreatitis: evidence from animal and human studies

Primary treatment of patients suffering from acute pancreatitis is conservative, irrespective of its etiology and initial severity. There is no effective specific therapy for treating the underlying disease process. As a result, the current therapeutic approach involves the provision of supportive care, the elimination of causal (biliary tract) disease, and the treatment of complications. Since complications may develop at any time, patients with moderate or severe disease should be admitted to an intensive care unit for interdisciplinary assessment and constant observation of their clinical status and computed tomography findings. Basic therapy should include total fasting, replacement of deficits in volume, electrolyte and albumin, as well as adequate analgesia. Depending on the patient's specific clinical condition, nasogastric suction, respiratory support, antibiotics, insulin and heparin may become necessary. The use of enzyme inhibitors and drugs capable of inhibiting pancreatic exocrine secretion has not proved effective in clinical trials. The value of prostaglandins, non-steroidal anti-inflammatory drugs and cholecystokinin receptor antagonists remains to be established. Early endoscopic retrograde cholangiopancreatography should be performed in patients with suspected underlying biliary disease. Papillotomy should be carried out only when calculi are present in the common bile duct. Local complications, such as pseudocysts and abscesses can often be treated by ultrasound- or CT-guided aspiration and drainage. However, when bacterial infection of pancreatic necrosis becomes evident, surgical intervention should be considered. Future evaluation of new therapeutic approaches by controlled studies needs to include a sufficient number of patients with severe acute pancreatitis.