What is viral pancreatitis?

From the Guidelines

Viral pancreatitis is a less common form of pancreatitis, typically caused by viral infections such as mumps virus, coxsackievirus, hepatitis viruses, cytomegalovirus, and Epstein-Barr virus, and its management focuses on supportive care, including pain management and hydration, with antiviral medications considered in immunocompromised patients. When considering the diagnosis of viral pancreatitis, it's essential to differentiate it from other forms of pancreatitis, such as infected severe acute pancreatitis, where antibiotics are always recommended to treat infected cases, as stated in the 2019 WSES guidelines for the management of severe acute pancreatitis 1.

Key Considerations

• The diagnosis of infected pancreatitis is challenging due to the clinical picture that cannot be distinguished from other infectious complications or from the inflammatory status caused by acute pancreatitis, as noted in the 2019 WSES guidelines 1.
• Serum measurements of procalcitonin (PCT) may be valuable in predicting the risk of developing infected pancreatic necrosis, with several studies demonstrating its effectiveness as a predictor for the severity of acute pancreatitis and the risk of developing infected pancreatitis 1.
• A CT-guided fine-needle aspiration (FNA) for Gram stain and culture can confirm an infected severe acute pancreatitis and drive antibiotic therapy, although it is no longer in routine use due to the high rate of false negative findings 1.

Management and Treatment

• Treatment for viral pancreatitis is primarily supportive, focusing on pain management with medications and maintaining hydration through intravenous fluids.
• Patients should initially fast to rest the pancreas, gradually reintroducing a low-fat diet as symptoms improve.
• Antiviral medications specific to the causative virus may be necessary in immunocompromised patients.

Prevention and Follow-up

• Prevention involves vaccination against viruses like mumps and hepatitis B, and practicing good hygiene to avoid viral infections.
• Follow-up imaging and pancreatic enzyme testing are important to monitor recovery and detect potential complications, such as pseudocysts, pancreatic necrosis, or progression to chronic pancreatitis.

From the Research

Definition and Incidence of Viral Pancreatitis

• Viral pancreatitis is not explicitly defined in the provided studies, but acute pancreatitis is described as a common gastrointestinal disease requiring hospitalization, with an increasing incidence 2, 3, 4.
• The exact cause of viral pancreatitis is not mentioned, but various causes of acute pancreatitis are listed, including gallstones, ethanol, hypertriglyceridaemia, and drugs 5, 3, 4.

Diagnosis and Treatment of Acute Pancreatitis

• The diagnosis of acute pancreatitis requires two of the following: upper abdominal pain, amylase/lipase ≥ 3 × upper limit of normal, and/or cross-sectional imaging findings 4.
• Initial treatment priorities include intravenous fluid resuscitation, analgesia, and enteral nutrition, with critical care and organ support, parenteral nutrition, antibiotics, and pancreatic exocrine and endocrine replacement therapy as needed 4.
• Recent advancements in management have focused on early phase medical interventions, optimization of supportive treatment, and minimally invasive interventions for infected necrosis 6.

Complications and Outcomes of Acute Pancreatitis

• Acute pancreatitis can lead to severe complications, including persistent organ failure, fluid and/or necrotic collections, and significant mortality 3, 4.
• The impact of acute pancreatitis can be devastating, and prevention or reduction of the risk of recurrence and progression to chronic pancreatitis requires proactive management 4.
• Future research and clinical trials are necessary to optimize current strategies and develop new therapeutic approaches for acute pancreatitis 6.

Management and Treatment Strategies

• Several scoring systems, such as the Bedside Index of Severity in Acute Pancreatitis (BISAP) and the Acute Physiology and Chronic Health Evaluation (APACHE) II tools, have good predictive capabilities for disease severity and mortality 3.
• Early and aggressive fluid resuscitation and early enteral nutrition are associated with lower rates of mortality and infectious complications 3.
• The underlying etiology of acute pancreatitis should be sought in all patients, and risk-reduction strategies, such as cholecystectomy and alcohol cessation counseling, should be used during and after hospitalization 3.