Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2006

Open Access 01-12-2006 | Review

Management of acute pancreatitis: current knowledge and future perspectives

Authors: Lorenzo Fantini, Paola Tomassetti, Raffaele Pezzilli

Published in: World Journal of Emergency Surgery | Issue 1/2006

Login to get access

Abstract

In recent years, a number of articles have been published on the treatment of acute pancreatitis in experimental models and most of them concerned animals with mild disease. However, it is difficult to translate these results into clinical practice. For example, infliximab, a monoclonal TNF antibody, was experimentally tested in rats and it was found to significantly reduce the pathologic score and serum amylase activity and also to alleviate alveolar edema and acute respiratory distress syndrome; however, no studies are available in clinical human acute pancreatitis. Another substance, such as interleukin 10, was efficacious in decreasing the severity and mortality of lethal pancreatitis in rats, but seems to have no effect on human severe acute pancreatitis. Thus, the main problem in acute pancreatitis, especially in the severe form of the disease, is the difficulty of planning clinical studies capable of giving reliable statistically significant answers regarding the benefits of the various proposed therapeutic agents previously tested in experimental settings.
According to the pathophysiology of acute pancreatitis, the efficacy of the drugs already available, such as gabexate mesilate, lexipafant and somatostatin should be re-evaluated and should be probably administered in a different manner. Of course, also in this case, we need adequate studies to test this hypothesis.
Literature
1.
Pezzilli R, Ceciliato R, Corinaldesi R: The pathogenesis of acute pancreatitis: from basic research to the bedside. Osp It Chir. 2004, 10: 314-323.
2.
Norman J: The role of cytokines in the pathogenesis of acute pancreatitis. Am J Surg. 1998, 175: 76-83. 10.1016/S0002-9610(97)00240-7.CrossRefPubMed
3.
Bradley EL: A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga., September 11 through 13, 1992. Arch Surg. 1993, 128 (5): 586-90.CrossRefPubMed
4.
Sarles H, Adler G, Dani R, Frey C, Gullo L, Harada H, Martin E, Norohna M, Scuro LA: Classifications of pancreatitis and definition of pancreatic diseases. Digestion. 1989, 43: 234-236.CrossRefPubMed
5.
United Kingdom guidelines for the management of acute pancreatitis. Gut. 1998, 42 (Suppl 2): S1-13.
6.
Working Party of the British Society of Gastroenterology; Association of Surgeons of Great Britain and Ireland; Pancreatic Society of Great Britain and Ireland; Association of Upper GI Surgeons of Great Britain and Ireland. UK guidelines for the management of acute pancreatitis. Gut. 2005, 54 (Suppl 3): iii 1-9.
7.
The Society for Surgery of the Alimentary Tract Patient Care Committee. Treatment of acute pancreatitis. J Gastrointest Surg. 1998, 2: 487-488. 10.1016/S1091-255X(98)80042-5.CrossRef
8.
Dervenis C, Johnson CD, Bassi C, Bradley EL, Imrie CW, McMahon MJ, Modlin I: Diagnosis, objective assessment of severity, and management of acute pancreatitis: Santorini consensus conference. Int J Pancreatol. 1999, 25: 195-210.PubMed
9.
Uomo G, Pezzilli R, Cavallini G, ProInf-A.I.S.P: Study Group. The management of acute pancreatitis in clinical practice. Ital J Gastroenterol Hepatol. 1999, 31: 635-642.PubMed
10.
Toouli J, Brooke-Smith M, Bassi C, Carr-Locke D, Telford J, Freeny P, Imrie C, Tandon R: Working Party of the Program Commitee of the Bangkok World Congress of Gastroenterology 2002. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol. 2002, 17 (Suppl): S15-39. 10.1046/j.1440-1746.17.s1.2.x.CrossRefPubMed
11.
Mayumi T, Ura H, Arata S, Kitamura N, Kiriyama I, Shibuya K, Sekimoto M, Nago N, Hirota M, Yoshida M, Ito Y, Hirata K, Takada T: Working Group for the Practical Guidelines for Acute Pancreatitis. Japanese Society of Emergency Abdominal Medicine. Evidence-based clinical practice guidelines for acute pancreatitis: proposals. J Hepatobiliary Pancreat Surg. 2002, 9: 413-422. 10.1007/s005340200051.CrossRefPubMed
12.
Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, Carter R, Di Magno E, Banks PA, Whitcomb DC, Dervenis C, Ulrich CD, Satake K, Ghaneh P, Hartwig W, Werner J, McEntee G, Neoptolemos JP, Buchler MW: International Association of Pancreatology. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002, 2: 565-573. 10.1159/000071269.CrossRefPubMed
13.
Bradley EL: Guiding the reluctant. A primer on guidelines in general and pancreatitis in particular. Pancreatology. 2003, 3: 139-143. 10.1159/000070082.CrossRefPubMed
14.
Gurusamy KS, Farouk M, Tweedie JH: UK guidelines for management of acute pancreatitis: is it time to change?. Gut. 2005, 54: 1344-1345. 10.1136/gut.2005.071076.PubMedCentralCrossRefPubMed
15.
Lankisch PG, Weber-Dany B, Lerch MM: Clinical perspectives in pancreatology: compliance with acute pancreatitis guidelines in Germany. Pancreatology. 2005, 5: 591-593. 10.1159/000087501.CrossRefPubMed
16.
Sargen K, Kingsnorth AN: Management of gallstone pancreatitis: effects of deviation from clinical guidelines. JOP. 2001, 2: 317-322.PubMed
17.
Ebbehoj N, Friis J, Svendsen LB, Bulow S, Madsen P: Indomethacin treatment of acute pancreatitis. A controlled double-blind trial. Scand J Gastroenterol. 1985, 20: 798-800.CrossRefPubMed
18.
Jakobs R, Adamek MU, von Bubnoff AC, Riemann JF: Buprenorphine or procaine for pain relief in acute pancreatitis. A prospective randomized study. Scand J Gastroenterol. 2000, 35: 1319-1323. 10.1080/003655200453692.CrossRefPubMed
19.
Stevens M, Esler R, Asher G: Transdermal fentanyl for the management of acute pancreatitis pain. Appl Nurs Res. 2002, 15: 102-110. 10.1053/apnr.2002.29532.CrossRefPubMed
20.
Kahl S, Zimmermann S, Pross M, Schulz HU, Schmidt U, Malfertheiner P: Procaine hydrochloride fails to relieve pain in patients with acute pancreatitis. Digestion. 2004, 69: 5-9. 10.1159/000076541.CrossRefPubMed
21.
22.
Navarro S, Ros E, Aused R, Garcia Puges M, Pique JM, Vilar Bonet J: Comparison of fasting, nasogastric suction and cimetidine in the treatment of acute pancreatitis. Digestion. 1984, 30: 224-230.CrossRefPubMed
23.
Sarr MG, Sanfey H, Cameron JL: Prospective, randomized trial of nasogastric suction in patients with acute pancreatitis. Surgery. 1986, 100: 500-504.PubMed
24.
Maisto OE, Bremner CG: Antacids in the treatment of acute alcohol-induced pancreatitis. S Afr Med J. 1983, 63: 351-2.PubMed
25.
Moreno-Otero R, Rodriguez S, Carbo J, Garcia-Buey L, Pajares JM: Double-blind trial of pirenzepine in acute pancreatitis. Digestion. 1989, 42: 51-56.CrossRefPubMed
26.
Oruc N, Ozutemiz AO, Nart VY, Celik HA, Yuce G, Batur Y: Infliximab: a new therapeutic agent in acute pancreatitis?. Pancreas. 2004, 28: E1-8. 10.1097/00006676-200401000-00020.CrossRefPubMed
27.
Lawinski M, Sledzinski Z, Kubasik-Juraniec J, Spodnik JH, Wozniak M, Boguslawski W: Does resveratrol prevent free radical-induced acute pancreatitis?. Pancreas. 2005, 31: 43-47. 10.1097/01.mpa.0000163021.40607.20.CrossRefPubMed
28.
Pastor CM, Frossard JL: Are genetically modified mice useful for the understanding of acute pancreatitis?. FASEB J. 2001, 15: 893-897. 10.1096/fj.00-0672rev.CrossRefPubMed
29.
Zou WG, Wang DS, Lang MF, Jin DY, Xu DH, Zheng ZC, Wu ZH, Liu XY: Human interleukin 10 gene therapy decreases the severity and mortality of lethal pancreatitis in rats. J Surg Res. 2002, 103: 121-126. 10.1006/jsre.2001.6327.CrossRefPubMed
30.
Villoria A, Abadía de Barbará C, Molero X, Álvarez A, Antolín M, Guarner L, Malagelada JR: Early treatment with interleukin-10 (IL-10) in severe acute pancreatitis. Pancreatology. 2003, 3: 466-
31.
Foitzik T, Eibl G, Schneider P, Wenger FA, Jacobi CA, Buhr HJ: Omega-3 fatty acid supplementation increases anti-inflammatory cytokines and attenuates systemic disease sequelae in experimental pancreatitis. JPEN J Parenter Enteral Nutr. 2002, 26: 351-356.CrossRefPubMed
32.
Lasztity N, Hamvas J, Biro L, Nemeth E, Marosvolgyi T, Decsi T, Pap A, Antal M: Effect of enterally administered n-3 polyunsaturated fatty acids in acute pancreatitis: a prospective randomized clinical trial. Clin Nutr. 2005, 24: 198-205. 10.1016/j.clnu.2004.12.008.CrossRefPubMed
33.
Mason J, Siriwardena AK: Designing future clinical trials in acute pancreatitis. Pancreatology. 2005, 5: 113-115. 10.1159/000085261.CrossRefPubMed
34.
Johnson CD, Kingsnorth AN, Imrie CW, McMahon MJ, Neoptolemos JP, McKay C, Toh SK, Skaife P, Leeder PC, Wilson P, Larvin M, Curtis LD: Double blind, randomised, placebo controlled study of a platelet activating factor antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis. Gut. 2001, 48: 62-69. 10.1136/gut.48.1.62.PubMedCentralCrossRefPubMed
35.
Abu-Zidan FM, Windsor JA: Lexipafant and acute pancreatitis: a critical appraisal of the clinical trials. Eur J Surg. 2002, 168: 215-219. 10.1080/11024150260102816.CrossRefPubMed
36.
Pezzilli R, Ceciliato R, Barakat B, Corinaldesi R: Immune-manipulation of the inflammatory response in acute pancreatitis. What can be expected?. JOP. 2004, 5: 115-21.PubMed
37.
Seta T, Noguchi Y, Shimada T, Shikata S, Fukui T: Treatment of acute pancreatitis with protease inhibitors: a meta-analysis. Eur J Gastroenterol Hepatol. 2004, 16: 1287-1293. 10.1097/00042737-200412000-00009.CrossRefPubMed
38.
Windsor AC, Kanwar S, Li AG, Barnes E, Guthrie JA, Spark JI, Welsh F, Guillou PJ, Reynolds JV: Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut. 1998, 42: 431-435.PubMedCentralCrossRefPubMed
39.
Eatock FC, Chong P, Menezes N, Murray L, McKay CJ, Carter CR, Imrie CW: A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol. 2005, 100: 432-439. 10.1111/j.1572-0241.2005.40587.x.CrossRefPubMed
40.
Olah A, Belagyi T, Issekutz A, Gamal ME, Bengmark S: Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis. Br J Surg. 2002, 89: 1103-1107. 10.1046/j.1365-2168.2002.02189.x.CrossRefPubMed
41.
Besselink MG, Timmerman HM, Buskens E, Nieuwenhuijs VB, Akkermans LM, Gooszen HG: Dutch Acute Pancreatitis Study Group. Probiotic prophylaxis in patients with predicted severe acute pancreatitis (PROPATRIA): design and rationale of a double-blind, placebo-controlled randomised multicenter trial ISRCTN38327949. BMC Surg. 2004, 4: 12-10.1186/1471-2482-4-12.PubMedCentralCrossRefPubMed
42.
Sharma VK, Howden CW: Prophylactic antibiotic administration reduces sepsis and mortality in acute necrotizing pancreatitis: a meta-analysis. Pancreas. 2001, 22: 28-31. 10.1097/00006676-200101000-00005.CrossRefPubMed
43.
Isenmann R, Runzi M, Kron M, Kahl S, Kraus D, Jung N, Maier L, Malfertheiner P, Goebell H, Beger HG: German Antibiotics in Severe Acute Pancreatitis Study Group. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. German Antibiotics in Severe Acute Pancreatitis Study Group. Gastroenterology. 2004, 126: 997-1004. 10.1053/j.gastro.2003.12.050.CrossRefPubMed
44.
Bassi C, Falconi M: Discussion on prophylactic antibiotic treatment in patients with predicted severe pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology. 2004, 27: 1015-1016. 10.1053/j.gastro.2004.07.045.CrossRef
45.
Pezzilli R: Antibiotic prophylaxis in acute necrotizing pancreatitis: yes or no?. JOP. 2004, 5: 161-4.PubMed
46.
Levy P, Heresbach D, Pariente EA, Boruchowicz A, Delcenserie R, Millat B, Moreau J, Le Bodic L, de Calan L, Barthet M, Sauvanet A, Bernades P: Frequency and risk factors of recurrent pain during refeeding in patients with acute pancreatitis: a multivariate multicentre prospective study of 116 patients. Gut. 1997, 40: 262-266.PubMedCentralCrossRefPubMed
47.
Levy P, Hastier P, Arotcarena R, Bartolie E, Bougeard-Julien M, Blumberg J, O'Toole D, Ruszniewski P: Efficacy of lanreotide 30 mg on prevention of pain relapse after oral refeeding in patients with necrotizing acute pancreatitis. A phase II prospective multicentre study. Pancreatology. 2004, 4: 229-232. 10.1159/000078434.CrossRefPubMed
48.
Ibars EP, Sanchez de Rojas EA, Quereda LA, Ramis RF, Sanjuan VM, Peris RT: Pancreatic function after acute biliary pancreatitis: does it change?. World J Surg. 2002, 26: 479-486. 10.1007/s00268-001-0253-7.CrossRefPubMed
49.
Pareja E, Artigues E, Aparisi L, Fabra R, Martinez V, Trullenque R: Exocrine pancreatic changes following acute attack of biliary pancreatitis. Pancreatology. 2002, 2: 478-483. 10.1159/000064715.CrossRefPubMed
50.
Sabater L, Pareja E, Aparisi L, Calvete J, Camps B, Sastre J, Artigues E, Oviedo M, Trullenque R, Lledo S: Pancreatic function after severe acute biliary pancreatitis: the role of necrosectomy. Pancreas. 2004, 28: 65-68. 10.1097/00006676-200401000-00010.CrossRefPubMed
51.
Migliori M, Pezzilli R, Tomassetti P, Gullo L: Exocrine pancreatic function after alcoholic or biliary acute pancreatitis. Pancreas. 2004, 28: 359-363. 10.1097/00006676-200405000-00001.CrossRefPubMed
Metadata
Title
Management of acute pancreatitis: current knowledge and future perspectives
Authors
Lorenzo Fantini
Paola Tomassetti
Raffaele Pezzilli
Publication date
01-12-2006
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2006
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/1749-7922-1-16

Other articles of this Issue 1/2006

World Journal of Emergency Surgery 1/2006 Go to the issue

Review

Questions about the use of antibiotics in acute pancreatitis

Case report

Repair of ascending aorta pseudoaneurysm without circulatory arrest in redo patient

Research article

The effect of Bosentan on healing of colonic anastomosis

Case report

Spontaneous biliary tract perforations: an unusual cause of peritonitis in pregnancy. Report of two cases and review of literature

Case report

Tubercular appendicitis – a case report

Research article

Plasma total anti-oxidant capacity correlates inversely with the extent of acute appendicitis: a case control study