This article provides an overview of acute pancreatitis (AP), emphasising its increasing global incidence & the need for comprehensive management strategies. These guidelines aim to provide evidence-based approaches for effectively managing AP and reducing associated morbidity & mortality.

Acute pancreatitis (AP)

Acute pancreatitis (AP) is a frequent gastrointestinal tract condition that requires hospital admission. It is described as acute inflammation of the pancreas. One of the gastrointestinal tract's most prevalent conditions, acute pancreatitis (AP) causes a patient to experience severe emotional, physical, and financial hardship.

The global incidence of AP ranges from 3.4 to 73.4 cases per 100,000 people and has been rising by 2%–5% per year. The population mortality rate has remained constant, with 5,000–9,000 deaths recorded yearly, despite a decline in the case fatality rate over time.

Although the majority of patients' symptoms subside within a few days, almost 20% of patients have problems, such as pancreatic necrosis and/or organ failure, which may call for extended hospital stays, critical care, and radiologic, surgical, and/or endoscopic intervention.

To identify and treat AP patients and avoid problems, early treatment is crucial. Surgery is usually necessary for patients with biliary pancreatitis to prevent the illness from returning. If cholangitis complicates the condition, early endoscopic retrograde cholangiopancreatography may also be necessary.

When it comes to treating AP sufferers, nutrition is crucial. The importance and safety of early refeeding in preventing complications associated with AP should be addressed.

The American College of Gastroenterology (ACG) has released guidelines that provide a realistic, evidence-based approach to managing patients with AP.

Management of AP: ACG recommendations

Aetiology

1. We suggest transabdominal ultrasound in patients with AP to evaluate for biliary pancreatitis and ultrasound if the initial examination is inconclusive. Conditional recommendation, very low-quality of evidence.
2. In patients with IAP, we suggest additional diagnostic evaluation with repeat abdominal ultrasound, MRI, and or endoscopic ultrasound. Conditional recommendation; very low-quality evidence.

Initial management

3. We suggest moderately aggressive fluid resuscitation for patients with AP. Additional boluses will be needed if there is evidence of hypovolemia. Conditional recommendation, low-quality of evidence.
4. We suggest using lactated Ringer solution over normal saline for intravenous resuscitation in AP. Conditional recommendation, low-quality of evidence

ERCP in AP

5. We suggest medical therapy over early (within the first 72 hr) ERCP in acute biliary pancreatitis without cholangitis. Conditional recommendation, low-quality of evidence

Preventing PEP

6. We recommend rectal indomethacin to prevent PEP in individuals considered to be at high risk of post-ERCP pancreatitis. Strong recommendation, moderate quality of evidence
7. We suggest the placement of a pancreatic duct stent in patients at high risk for PEP who are receiving rectal indomethacin. Conditional recommendation, low quality of evidence.

The role of antibiotics in AP

8. We suggest against prophylactic antibiotics in patients with severe AP. Conditional recommendation, very low-quality evidence.
9. We suggest against FNA (fine-needle aspiration) in patients with suspected infected pancreatic necrosis. Conditional recommendation, very low quality of evidence.

Nutrition in AP

10. In patients with mild AP, we suggest early oral feeding (within 24–48 hr) as tolerated by the patient compared with the traditional NPO approach. Conditional recommendation, low-quality of evidence
11. In patients with mild AP, we suggest initial oral feeding with a low-fat solid diet rather than a stepwise liquid-to-solid approach. Conditional recommendation, low quality of evidence.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.