From the Guidelines
Pancreatitis treatment should focus on supportive care, including enteral nutrition, IV pain medications, early fluid resuscitation, and mechanical ventilation as needed, without routine prophylactic antibiotics, as recommended by the most recent guidelines 1. The management of pancreatitis involves a multidisciplinary approach to reduce morbidity, mortality, and improve quality of life.
Key Components of Treatment
- Enteral nutrition (oral, NG, or NJ) is preferred, with parenteral nutrition considered if enteral nutrition is not tolerated 1.
- IV pain medications are essential for pain control.
- Early fluid resuscitation is critical to prevent complications.
- Mechanical ventilation may be necessary in severe cases.
Laboratory Evaluation and Monitoring
- Procalcitonin (PCT) levels can help diagnose infected severe acute pancreatitis 1.
- CT- or EUS-guided fine-needle aspiration (FNA) for Gram stain and culture can aid in diagnosing infection.
- Endoscopic retrograde cholangiopancreatography (ERCP) is recommended for patients with acute biliary pancreatitis and common bile duct obstruction as soon as possible 1.
Antibiotic Use
- Antibiotics are only recommended for treating infected severe acute pancreatitis, not for prophylactic use in all patients with acute pancreatitis 1.
- The diagnosis of infected severe acute pancreatitis can be challenging, and antibiotics should be used judiciously.
Nutrition Support
- Nutritional support is crucial in patients with pancreatitis, especially those with severe disease or malnutrition 1.
- Enteral nutrition is preferred, but parenteral nutrition may be necessary in some cases.
- Patients with chronic pancreatitis are at risk of malnutrition and should be screened and supplemented accordingly 1.
From the Research
Pancreatitis Treatment
- The treatment of acute pancreatitis involves fundamental medical treatment consisting of fasting, intravenous (IV) fluid replacement, and analgesics with a close monitoring of vital signs 2.
- Assessment of severity based on clinical signs, blood test, urinalysis, and imaging tests should be performed to determine the way of treatment for each patient 2.
- Early aggressive intravenous hydration with Lactated Ringer's solution has been shown to hasten clinical improvement in patients with mild acute pancreatitis 3.
- However, a recent meta-analysis found that aggressive fluid resuscitation increased the risk of all-cause mortality as compared to moderate fluid replacement 4.
Laboratory Tests
- Laboratory tests such as hematocrit, blood urea nitrogen (BUN), and creatinine are used to assess the severity of acute pancreatitis and guide treatment 3.
- These tests are also used to monitor the patient's response to treatment and adjust the treatment plan as needed 3.
- Procalcitonin-based algorithm of antibiotic use has recently been investigated to distinguish between inflammation and infection in patients with acute pancreatitis 5.
Fluid Replacement
- The type, rate, volume, and duration of fluid replacement are important considerations in the treatment of acute pancreatitis 5.
- Lactated Ringer's solution is recommended for fluid replacement in acute pancreatitis, and goal-directed and non-aggressive hydration is preferred over aggressive hydration with normal saline 5.
- Aggressive hydration with Lactated Ringer's solution has been shown to reduce the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis 6.
Other Treatment Strategies
- Early enteral feeding is becoming a definitive treatment strategy for acute pancreatitis, and the routine use of prophylactic antibiotics is generally limited 5.
- Urgent ERCP should be performed for patients with gallstone pancreatitis and cholangitis, but is not indicated in patients without cholangitis 5.
- The management approach for patients with local complications of acute pancreatitis, particularly those with infected necrotizing pancreatitis, involves indications, timing, anatomical considerations, and selection of intervention methods 5.