Current trends in acute pancreatitis: Diagnostic and therapeutic challenges

Abstract

Acute pancreatitis (AP) is an inflammatory disease of the pancreas, which can progress to severe AP, with a high risk of death. It is one of the most complicated and clinically challenging of all disorders affecting the abdomen. The main causes of AP are gallstone migration and alcohol abuse. Other causes are uncommon, controversial and insufficiently explained. The disease is primarily characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. According to the revised Atlanta classification, severity of the disease is categorized into three levels: Mild, moderately severe and severe, depending upon organ failure and local as well as systemic complications. Various methods have been used for predicting the severity of AP and its outcome, such as clinical evaluation, imaging evaluation and testing of various biochemical markers. However, AP is a very complex disease and despite the fact that there are of several clinical, biochemical and imaging criteria for assessment of severity of AP, it is not an easy task to predict its subsequent course. Therefore, there are existing controversies regarding diagnostic and therapeutic modalities, their effectiveness and complications in the treatment of AP. The main reason being the fact, that the pathophysiologic mechanisms of AP have not been fully elucidated and need to be studied further. In this editorial article, we discuss the efficacy of the existing diagnostic and therapeutic modalities, complications and treatment failure in the management of AP.

Keywords: Pancreatitis, Etiology and pathogenesis, Diagnostic criteria, Nutrition, Antibiotics, Management of complications

Core Tip: Acute pancreatitis (AP) is an inflammatory disease of the pancreas, with abnormal trypsinogen activation as the primary pathogenesis and varies from clinically mild to fulminant form. Severe forms of AP are a relatively common cause of death. Progress in the establishment of biochemical, imaging and clinical criteria for the severity and prognosis of the disease has markedly influenced the therapeutic approach and the outcome of the disease. This article presents the diagnostic and therapeutic modalities with regard to their effectiveness, complications and treatment failure, as well as discussing some of the controversial issues in the treatment of AP.