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2018 ; 7
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Recent advances in understanding and managing acute pancreatitis
#MMPMID30026919
Mandalia A
; Wamsteker EJ
; DiMagno MJ
F1000Res
2018[]; 7
(ä): ä PMID30026919
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This review highlights advances made in recent years in the diagnosis and
management of acute pancreatitis (AP). We focus on epidemiological, clinical, and
management aspects of AP. Additionally, we discuss the role of using risk
stratification tools to guide clinical decision making. The majority of patients
suffer from mild AP, and only a subset develop moderately severe AP, defined as a
pancreatic local complication, or severe AP, defined as persistent organ failure.
In mild AP, management typically involves diagnostic evaluation and supportive
care resulting usually in a short hospital length of stay (LOS). In severe AP, a
multidisciplinary approach is warranted to minimize morbidity and mortality over
the course of a protracted hospital LOS. Based on evidence from guideline
recommendations, we discuss five treatment interventions, including intravenous
fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of
endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary
pancreatitis. This review also highlights the importance of preventive
interventions to reduce hospital readmission or prevent pancreatitis, including
alcohol and smoking cessation, same-admission cholecystectomy for acute biliary
pancreatitis, and chemoprevention and fluid administration for post-ERCP
pancreatitis. Our review aims to consolidate guideline recommendations and
high-quality studies published in recent years to guide the management of AP and
highlight areas in need of research.