From the Guidelines
The treatment for pancreatitis should prioritize enteral nutrition, pain management, and addressing the underlying cause, with a focus on reducing morbidity, mortality, and improving quality of life, as recommended by the most recent guidelines 1.
Overview of Treatment
The treatment approach for pancreatitis varies depending on whether it's acute or chronic. For acute pancreatitis, the focus is on supportive care, including:
- Enteral nutrition (oral, NG, or NJ) to support the pancreas and prevent malnutrition
- IV pain medications to manage pain
- Early fluid resuscitation to prevent dehydration and support organ function
- Mechanical ventilation if necessary to support respiratory function
Key Considerations
- No specific pharmacological treatment is recommended except for organ support and nutrition, as prophylactic antibiotics are not associated with a significant decrease in mortality or morbidity 1.
- Antibiotics are only recommended to treat infected severe acute pancreatitis, and the diagnosis of infection can be challenging due to the clinical picture resembling other infectious complications or inflammatory status caused by acute pancreatitis 1.
- CT- or EUS-guided fine-needle aspiration (FNA) for Gram stain and culture can be used to diagnose infection, and endoscopic retrograde cholangiopancreatography (ERCP) may be necessary for patients with acute biliary pancreatitis and common bile duct obstruction 1.
Nutritional Support
- Enteral nutrition is the preferred method of nutritional support, and parenteral nutrition should only be used if enteral nutrition is not tolerated or possible 1.
- Early enteral feeding can decrease the incidence of nosocomial infection, reduce the duration of systemic inflammatory response syndrome (SIRS), and decrease overall disease severity 1.
Pain Management
- Pain control is crucial, and medications such as morphine, hydromorphone, or fentanyl can be used to manage pain.
- Alcohol cessation is essential for alcohol-induced pancreatitis, as continued drinking can worsen the condition.
Chronic Pancreatitis
- Treatment focuses on pain control, enzyme replacement therapy, and addressing the underlying cause.
- Enzyme replacement therapy (e.g., Creon or Pancreaze) can aid digestion, and alcohol cessation is crucial for alcohol-induced pancreatitis.
From the FDA Drug Label
Delayed- and immediate-release pancreatic enzyme products with different formulations of the same active ingredient (pancrelipase) have been used for the treatment of patients with exocrine pancreatic insufficiency due to cystic fibrosis and other conditions, such as chronic pancreatitis
The treatment for pancreatitis may involve pancreatic enzyme replacement therapy, such as pancrelipase, in patients with exocrine pancreatic insufficiency due to conditions like chronic pancreatitis 2.
- Key points:
- Pancrelipase is used for the treatment of exocrine pancreatic insufficiency due to cystic fibrosis or other conditions.
- The treatment of pancreatitis may involve pancreatic enzyme replacement therapy.
- Pancrelipase has a well-defined and favorable risk-benefit profile in exocrine pancreatic insufficiency.
From the Research
Treatment Overview
The treatment for pancreatitis typically involves a combination of supportive care, medication, and in some cases, surgery. The primary goals of treatment are to manage symptoms, prevent complications, and support the recovery of the pancreas.
Supportive Care
- Hospitalization is often required for patients with acute pancreatitis, as stated in 3 and 4
- Monitoring of vital signs, including conscious state, respiratory and cardiovascular system, and urinary output, is crucial, as mentioned in 3 and 4
- Adequate fluid replacement is essential to stabilize cardiovascular dynamics, with the dose adjusted based on circulatory dynamics, as noted in 3 and 4
- Pain control is also an important aspect of supportive care, as mentioned in 3, 5, and 6
- Nutritional support, including enteral feeding, is recommended, as stated in 3, 5, and 4
Medication
- Prophylactic antibiotic administration is recommended to prevent infectious complications in patients with severe acute pancreatitis, as mentioned in 3 and 4
- The use of protease inhibitors is still a matter of controversy, but there is a consensus in Japan that a large dose of a synthetic protease inhibitor should be given to patients with severe acute pancreatitis, as noted in 3 and 4
- Other medications, such as analgesics and anti-inflammatory agents, may also be used to manage symptoms and support recovery, as mentioned in 5 and 6
Surgery and Interventional Procedures
- Surgery may be necessary in some cases, such as to remove gallstones or to treat complications like infected necrotizing pancreatitis, as mentioned in 5 and 6
- Interventional procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), may also be used to treat certain complications, as noted in 5 and 6
- Blood purification therapy and continuous regional arterial infusion of a protease inhibitor and antibiotics may be recommended as optional measures, as stated in 3 and 4
Convalescent Treatment
- Convalescent treatment, including cholecystectomy in gallstone pancreatitis, lipid-lowering medications in hypertriglyceridemia-induced AP, and alcohol intervention in alcoholic pancreatitis, is important for improving prognosis and preventing recurrence, as mentioned in 5 and 6
- Long-term management may be necessary for some patients to reduce the risk of recurrence and progression to chronic pancreatitis, as noted in 6