Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Feb 15, 2016; 7(1): 186-198
Published online Feb 15, 2016. doi: 10.4291/wjgp.v7.i1.186
Intra-abdominal pressure: Time ripe to revise management guidelines of acute pancreatitis?
Jiten Jaipuria, Vimal Bhandari, Avneet Singh Chawla, Mohit Singh
Jiten Jaipuria, Vimal Bhandari, Avneet Singh Chawla, Mohit Singh, Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
Author contributions: Jaipuria J initially conceptualized the idea of paper; Jaipuria J and Bhandari V performed the literature search; all authors read the manuscripts selected in initial search; initial draft was prepared by Jaipuria J which was further modified by intellectual inputs by all the authors; all authors approved the final draft.
Conflict-of-interest statement: All authors have no conflicts of interest or financial ties to disclose.
Data sharing statement: All data pertaining to review was obtained from PubMed, Medline, Scopus and Google search of open access sources. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jiten Jaipuria, MS, MRCS (Edinburgh), FIAGES, Senior Registrar, Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India. jitenjaipuria@yahoo.co.in
Telephone: +91-98-68812182 Fax: +91-11-26163072
Received: June 30, 2015
Peer-review started: July 4, 2015
First decision: July 29, 2015
Revised: September 8, 2015
Accepted: November 3, 2015
Article in press: November 4, 2015
Published online: February 15, 2016
Processing time: 215 Days and 13.3 Hours
Abstract

AIM: To systematically review evidence on pathophysiology of intra-abdominal pressure (IAP) in acute pancreatitis (AP) with its clinical correlates.

METHODS: Systematic review of available evidence in English literature with relevant medical subject heading terms on PubMed, Medline and Scopus with further search from open access sources on internet as suggested by articles retrieved.

RESULTS: Intra-abdominal hypertension (IAH) is increasingly gaining recognition as a point of specific intervention with potential to alter disease outcome and improve mortality in AP. IAH can be expected in at least 17% of patients presenting with diagnosis of AP to a typical tertiary care hospital (prevalence increasing to 50% in those with severe disease). Abdominal compartment syndrome can be expected in at least 15% patients with severe disease. Recent guidelines on management of AP do not acknowledge utility of surveillance for IAP other than those by Japanese Society of Hepato-Biliary-Pancreatic Surgery. We further outline pathophysiologic mechanisms of IAH; understanding of which advances our knowledge and helps to coherently align common observed variations in management related conundrums (such as fluid therapy, nutrition and antibiotic prophylaxis) with potential to further individualize treatment in AP.

CONCLUSION: We suggest that IAP be given its due place in future practice guidelines and that recommendations be formed with help of a broader panel with inclusion of clinicians experienced in management of IAH.

Keywords: Intra-abdominal hypertension; Abdominal compartment syndrome; Pancreatitis; Practice guideline

Core tip: Intra-abdominal hypertension is not merely an epiphenomenon but offers a unique point of specific intervention in acute pancreatitis and there is increasing data to show improved mortality with appropriate management. It is frequent and may be observed in at least 50% patients with severe disease. Moreover it acts as confounder in management related issues of fluid therapy, nutritional support and antibiotic prophylaxis; and understanding its pathophysiology coherently explains many dichotomies which presently lowers internal validity of much available evidence. Incorporating surveillance for intra-abdominal pressure in select subgroup of patients may help better tailor individualized treatment to patients with most severe spectrum of disease. Recommendations by World Society of the Abdominal Compartment Syndrome may be followed by practicing clinician to guide decision making.