-
Digestion 2021Severe acute pancreatitis (AP) continues to be a serious gastrointestinal disease with relevant morbidity and mortality. (Review)
Review
BACKGROUND
Severe acute pancreatitis (AP) continues to be a serious gastrointestinal disease with relevant morbidity and mortality.
SUMMARY
Successful clinical management requires close interdisciplinary cooperation and coordination from experienced gastroenterologists, intensive care physicians, surgeons, and radiologists. While the early phase of the disease is characterized by intensive care aspects that focus primarily on treatment of organ failure, later complications are characterized especially by (infected) necrotic collections. Here, we discuss current clinical standards and developments for conservative and interventional management of patients with severe AP. Key messages: Early targeted fluid therapy within the first 48 h is critical to improve the outcome of severe AP. Thoracic epidural analgesia may have prognostically beneficial effects due to suspected anti-inflammatory effects and increased perfusion of splanchnic vessels. Enteral feeding should be started early during severe AP. Persistent organ failure (>48 h) is the strongest predictor of poor prognosis, and local complications such as infected walled-off necrosis should be primarily treated by minimally invasive endoscopic step-up approaches that are usually superior to surgical therapy options.
Topics: Acute Disease; Humans; Pancreatitis
PubMed: 32422634
DOI: 10.1159/000506830 -
Journal of Veterinary Internal Medicine Nov 2021In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination,... (Review)
Review
In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination, advanced imaging, and immunoassays for the measurement of pancreatic lipase. Our aim is to provide a state-of-the-art overview of the clinical diagnosis of acute pancreatitis (AP) in dogs with a particular focus on pancreatic lipase assay validation and clinical performance, in addition to advanced imaging modalities. We also discuss the potential indications for cytology and histopathology in dogs with suspected AP.
Topics: Acute Disease; Animals; Dog Diseases; Dogs; Lipase; Pancreas; Pancreatitis; Ultrasonography
PubMed: 34751442
DOI: 10.1111/jvim.16292 -
Pediatric Clinics of North America Dec 2021Pediatric pancreatitis describes a spectrum covering acute pancreatitis, acute recurrent pancreatitis, and chronic pancreatitis, each with varying clinical... (Review)
Review
Pediatric pancreatitis describes a spectrum covering acute pancreatitis, acute recurrent pancreatitis, and chronic pancreatitis, each with varying clinical manifestations and risk factors requiring a tailored diagnostic approach. We emphasize management strategies based on age, risk factors, recurrence, and complications. A discussion of the role of therapeutic endoscopy is reviewed and highlights the growing role of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in children with pancreatitis. Particular diagnostic challenges in autoimmune pancreatitis are reviewed with an emphasis on differentiating this entity from alternate pancreaticobiliary pathologies. Finally, we explore a multidisciplinary approach to acute recurrent and chronic pancreatitis.
Topics: Acute Disease; Adolescent; Age Factors; Autoimmune Pancreatitis; Child; Child, Preschool; Cholangiopancreatography, Endoscopic Retrograde; Endoscopy; Fluid Therapy; Humans; Infant; Malnutrition; Nutrition Therapy; Pain Management; Pancreatitis; Pancreatitis, Chronic; Recurrence; Risk Factors
PubMed: 34736589
DOI: 10.1016/j.pcl.2021.07.012 -
International Journal of Environmental... Dec 2022Acute and chronic pancreatitis, until recently observed incidentally in pregnancy, has occurred much more frequently in the last 2-3 decades. Particularly severe... (Review)
Review
Acute and chronic pancreatitis, until recently observed incidentally in pregnancy, has occurred much more frequently in the last 2-3 decades. Particularly severe complications for the mother and fetus may be a consequence of acute pancreatitis. Therefore, it is important to know more about the diagnostic and therapeutic possibilities of pancreatic diseases in the course of pregnancy. Epidemiology, causes, clinical characteristics, differential diagnosis, and complex management are presented in this review. Particular emphasis is on the prevention of acute pancreatitis (AP) through the proper diagnosis and treatment of cholelithiasis and hypertriglyceridemia, both before and during pregnancy. The most up-to-date reports and management strategies are presented. This publication contributes to a wide group of scientists and practitioners better understanding the discussed issues, and indicates the directions of research for the future.
Topics: Pregnancy; Female; Humans; Pancreatitis; Acute Disease; Pregnancy Complications; Hypertriglyceridemia; Cholelithiasis
PubMed: 36498253
DOI: 10.3390/ijerph192316179 -
The Turkish Journal of Gastroenterology... Aug 2023Acute pancreatitis, a prevalent illness with devastating consequences, poses a grave threat to those affected. There has been a steady increase in the occurrence of...
Acute pancreatitis, a prevalent illness with devastating consequences, poses a grave threat to those affected. There has been a steady increase in the occurrence of acute pancreatitis at about 3% per year from 1961 to 2016. There are 3 main guidelines on acute pancreatitis, including the American College of Gastroenterology, the International Association of Pancreatology/American Pancreatic Association guideline in 2013, and the American Gastroenterological Association guideline in 2018. However, several milestone studies have been published since then. We hereby reviewed the current acute pancreatitis guidelines with an update on clinical practicechanging literature. The aggressive or moderate fluid resuscitation in acute pancreatitis (WATERFALL) trial recommended fluid resuscitation with lactated Ringer's solution at a moderate aggressive rate. All guidelines did not recommend prophylactic antibiotics use. Early enteral feeding reduces morbidity. A clear liquid diet is no longer recommended. Nutrition with nasogastric or nasojejunal feeding does not have a difference. The upcoming high vs. low-energy administration in the early phase of acute pancreatitis (GOULASH) trial will provide more information on the impact of calorie intake. Pain management should be individualized based on the degree of pain and severity of pancreatitis. In patients with moderate to severe and severe acute pancreatitis, a step-down approach with epidural analgesia can be considered for moderate to severe pain. The management of acute pancreatitis has evolved. New research on the impact of electrolytes, pharmacologic agents, the role of anticoagulants, and nutrition support will provide scientific and clinical evidence to improve patient care and decrease morbidity and mortality.
Topics: Humans; Pancreatitis; Acute Disease; Enteral Nutrition; Nutritional Support; Pancreas
PubMed: 37404118
DOI: 10.5152/tjg.2023.23175 -
Gastroenterology Jan 2022Acute pancreatitis is a common disease with significant associated morbidity and mortality. We performed a systematic review and meta-analysis of population-based... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
Acute pancreatitis is a common disease with significant associated morbidity and mortality. We performed a systematic review and meta-analysis of population-based studies to explore the changing temporal trends of acute pancreatitis incidence globally.
METHODS
We performed a systematic literature search to identify population-based studies reporting the annual incidence of acute pancreatitis. Abstracts were assessed independently to identify applicable articles for full-text review and data extraction. Joinpoint temporal trend analyses were performed to calculate the average annual percent change (AAPC) with 95% confidence intervals (CIs). The AAPCs were pooled in a meta-analysis to capture the overall and regional trends in acute pancreatitis incidence over time. Temporal data were summarized in a static map and an interactive, web-based map.
RESULTS
Forty-four studies reported the temporal incidence of acute pancreatitis (online interactive map: https://kaplan-acute-pancreatitis-ucalgary.hub.arcgis.com/). The incidence of acute pancreatitis has increased from 1961 to 2016 (AAPC, 3.07%; 95% CI, 2.30% to 3.84%; n = 34). Increasing incidence was observed in North America (AAPC, 3.67%; 95% CI, 2.76% to 4.57%; n = 4) and Europe (AAPC, 2.77%; 95% CI, 1.91% to 3.63%; n = 23). The incidence of acute pancreatitis was stable in Asia (AAPC, -0.28%; 95% CI, -5.03% to 4.47%; n = 4).
CONCLUSIONS
This meta-analysis provides a comprehensive overview of the global incidence of acute pancreatitis over the last 56 years and demonstrates a steadily rising incidence over time in most countries of the Western world. More studies are needed to better define the changing incidence of acute pancreatitis in Asia, Africa, and Latin America.
Topics: Acute Disease; Female; Global Health; Humans; Incidence; Male; Pancreatitis; Sex Distribution; Time Factors
PubMed: 34571026
DOI: 10.1053/j.gastro.2021.09.043 -
Radiologia 2019Acute pancreatitis is common and requires multidisciplinary management. The revised Atlanta classification, published in 2012, defines the terminology necessary to... (Review)
Review
Acute pancreatitis is common and requires multidisciplinary management. The revised Atlanta classification, published in 2012, defines the terminology necessary to enable specialists from different backgrounds to discuss the morphological and clinical types of acute pancreatitis. Radiologists' role depends fundamentally on computed tomography (CT), which makes it possible to classify the morphology of this disease and to predict its clinical severity by applying imaging severity indices. Furthermore, CT- or ultrasound-guided drainage is, together with endoscopy, the current technique of choice in the initial approach to collections that appear as a complication. This paper aims to disseminate the concepts coined in the revised Atlanta classification and to describe the current role of radiologists in the diagnosis and treatment of acute pancreatitis.
Topics: Acute Disease; Humans; Multidetector Computed Tomography; Pancreatitis
PubMed: 31153603
DOI: 10.1016/j.rx.2019.04.001 -
BMJ (Clinical Research Ed.) Dec 2019The risks, measurements of severity, and management of severe acute pancreatitis and its complications have evolved rapidly over the past decade. Evidence suggests that... (Review)
Review
The risks, measurements of severity, and management of severe acute pancreatitis and its complications have evolved rapidly over the past decade. Evidence suggests that initial goal directed therapy, nutritional support, and vigilance for pancreatic complications are best practice. Patients can develop pancreatic fluid collections including acute pancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Several randomized controlled trials and cohort studies have recently highlighted the advantage of managing these conditions with a progressive approach, with initial draining for infection followed by less invasive techniques. Surgery is no longer an early intervention and may not be needed. Instead, interventional radiologic and endoscopic methods seem to be safer with at least as good survival outcomes. Newly developed evidence based quality indicators are available to assess and improve performance. Development and clinical testing of drugs to target the mechanisms of disease are necessary for further advancements.
Topics: Acute Disease; Conservative Treatment; Disease Management; Drainage; Endoscopy; Humans; Pancreatitis; Progressive Patient Care
PubMed: 31791953
DOI: 10.1136/bmj.l6227 -
Current Opinion in Clinical Nutrition... Sep 2022This review intends to discuss recently available evidence in three topics related to nutrition in patients with acute pancreatitis, namely timing of refeeding, type of... (Review)
Review
PURPOSE OF REVIEW
This review intends to discuss recently available evidence in three topics related to nutrition in patients with acute pancreatitis, namely timing of refeeding, type of nutritional therapy and its route of administration.
RECENT FINDINGS
Recent lines of research confirm that early oral feeding leads to shorter length of stay, fewer complications and lower costs in patients with acute pancreatitis. Moreover, early (<48 h) enteral nutrition led to decreased hospital mortality in patients with mild and severe acute pancreatitis; thus, in case of intolerance to oral feeding or severe disease, nutritional therapy should be offered within 24-72 h. Furthermore, enteral nutrition should be preferred against parenteral nutrition, as it is related to shorter length of stay and less complications, while initial data bring to light the potential role of the soluble dietary fibre polydextrose as an agent that could lead to faster achievement of energy goal with concomitant lower rates of feeding intolerance. Finally, enteral nutrition can be administered through gastric or jejunal feeding, depending on digestive tolerance, whereas latest data also address the safety of percutaneous gastrostomy with a jejunal extension for enteral nutrition administration. However, more data about its real benefit are warranted.
SUMMARY
Accumulating evidence confirms the importance of early oral refeeding or early administration of enteral nutrition as vital parts of the armamentarium for the management of patients with acute pancreatitis.
Topics: Acute Disease; Enteral Nutrition; Humans; Infant, Newborn; Pancreatitis; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 35787593
DOI: 10.1097/MCO.0000000000000851 -
Journal of Veterinary Internal Medicine Mar 2021Pancreatitis in cats, although commonly diagnosed, still presents many diagnostic and management challenges.
BACKGROUND
Pancreatitis in cats, although commonly diagnosed, still presents many diagnostic and management challenges.
OBJECTIVE
To summarize the current literature as it relates to etiology, pathogenesis, diagnosis, and management of pancreatitis in cats and to arrive at clinically relevant suggestions for veterinary clinicians that are based on evidence, and where such evidence is lacking, based on consensus of experts in the field.
ANIMALS
None.
METHODS
A panel of 8 experts in the field (5 internists, 1 radiologist, 1 clinical pathologist, and 1 anatomic pathologist), with support from a librarian, was formed to assess and summarize evidence in the peer reviewed literature and complement it with consensus clinical recommendations.
RESULTS
There was little literature on the etiology and pathogenesis of spontaneous pancreatitis in cats, but there was much in the literature about the disease in humans, along with some experimental evidence in cats and nonfeline species. Most evidence was in the area of diagnosis of pancreatitis in cats, which was summarized carefully. In contrast, there was little evidence on the management of pancreatitis in cats.
CONCLUSIONS AND CLINICAL IMPORTANCE
Pancreatitis is amenable to antemortem diagnosis by integrating all clinical and diagnostic information available, and recognizing that acute pancreatitis is far easier to diagnose than chronic pancreatitis. Although both forms of pancreatitis can be managed successfully in many cats, management measures are far less clearly defined for chronic pancreatitis.
Topics: Acute Disease; Animals; Cat Diseases; Cats; Consensus; Pancreatitis
PubMed: 33587762
DOI: 10.1111/jvim.16053