Acute Pancreatitis: An Update of Evidence-Based Management and Recent Trends in Treatment Strategies

Abstract

Acute pancreatitis is a common gastrointestinal disease leading to hospitalisation. Recent advancements in its management have primarily focussed on the development of early phase medical interventions targeting inflammatory pathways, optimisation of supportive treatment (including fluid resuscitation, pain management and nutritional management), appropriate use of antibiotics, implementation of minimally invasive interventions for infected necrosis, and the necessity of follow-up for long-term complications. These advancements have significantly improved personalised management and overall outcomes of acute pancreatitis. Despite these efforts, early-phase medical interventions to mitigate disease progression are still lacking and acute pancreatitis remains a heterogeneous disease. Future research and clinical trials are imperative to further optimise current strategies and develop new therapeutic approaches. This review presents an evidence-based approach to the management of acute pancreatitis, highlighting recent developments.

Keywords: acute pancreatitis; antibiotics; conservative management; fluids; interventions; nutrition; pain management; treatment.

FIGURE 1

Core recommendations for the management of acute pancreatitis. CT, computed tomography; NSAIDs, nonsteroidal anti‐inflammatory drugs.

FIGURE 2

Evidence‐based management of acute pancreatitis flow diagram. [1] 1.5 mL/kg/h with Ringer's lactate, [2] early oral feeding and step‐up to tube feeding if insufficient after 72 h, [3] according to World Health Organisation (WHO) ladder, [4] start antibiotics if procalcitonin > 1 μg/L and stop if < 1 μg/L.