What are the causes and treatment options for acute pancreatitis?

From the Guidelines

Acute pancreatitis is primarily treated with supportive care, focusing on pain management, aggressive intravenous fluid resuscitation, and bowel rest, with enteral nutrition preferred over parenteral nutrition in severe cases, as recommended by the most recent guidelines 1. The most common causes of acute pancreatitis are gallstones and alcohol consumption, followed by medications, hypertriglyceridemia, hypercalcemia, trauma, and post-ERCP complications.

• Treatment should prioritize pain management with medications like morphine or hydromorphone
• Aggressive intravenous fluid resuscitation, typically with lactated Ringer's solution at 5-10 mL/kg/hr initially, is crucial
• Patients should avoid oral intake until pain improves and inflammatory markers decrease, then gradually advance to a low-fat diet
• Severe cases may require intensive care monitoring, nutritional support via enteral feeding, and treatment of complications like pseudocysts or infected necrosis
• Addressing the underlying cause is crucial, which may involve cholecystectomy for gallstone pancreatitis, alcohol cessation counseling, or discontinuation of offending medications, as supported by previous guidelines 1 The management of acute pancreatitis should be guided by the severity of the disease, with early recognition and management essential to prevent systemic inflammatory response syndrome, multi-organ failure, and death, which can occur in approximately 10% of severe cases 1.
• Enteral nutrition is recommended, with parenteral nutrition used only if enteral nutrition is not tolerated 1
• Prophylactic antibiotics are not recommended for all patients with acute pancreatitis, but should be used to treat infected severe acute pancreatitis 1
• Early fluid resuscitation, mechanical ventilation, and other supportive measures should be used as needed to manage severe cases 1

From the FDA Drug Label

Several cases of pancreatitis have been reported in patients receiving octreotide acetate therapy A few patients developed acute cholecystitis, ascending cholangitis, biliary obstruction, cholestatic hepatitis, or pancreatitis during octreotide acetate injection therapy or following its withdrawal. The causes of acute pancreatitis are not explicitly stated in the provided drug labels, but pancreatitis is reported as a potential adverse event associated with octreotide acetate therapy. The treatment for acute pancreatitis is not mentioned in the provided drug labels. 2 2

From the Research

Causes of Acute Pancreatitis

• Gallstones and ethanol are the most common causes of acute pancreatitis 3
• Hypertriglyceridaemia and drugs are also notable causes of acute pancreatitis 3
• Other causes of acute pancreatitis include various factors that can trigger pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses 3

Treatment of Acute Pancreatitis

• Initial management should focus on fluid resuscitation, with lactated Ringer's solution preferred over physiological saline 4, 5
• Early oral feeding should be encouraged, and use of parenteral nutrition is discouraged 4
• Routine use of prophylactic antibiotics in acute pancreatitis is not recommended, nor is urgent endoscopic retrograde cholangiopancreatography in the absence of concomitant acute cholangitis 4
• Cholecystectomy during the same admission of biliary pancreatitis should be performed to prevent future acute pancreatitis episodes 4
• Patients with acute pancreatitis secondary to alcohol should receive alcohol counseling 4
• Aggressive fluid resuscitation is associated with higher mortality as compared to moderate fluid replacement in patients with acute pancreatitis 6

Management Strategies

• Risk stratification, fluid and nutritional management, and follow-up care and risk-reduction strategies are crucial in managing acute pancreatitis 7
• Scoring systems, such as the Bedside Index of Severity in Acute Pancreatitis (BISAP) and the Acute Physiology and Chronic Health Evaluation (APACHE) II tools, can help predict disease severity and mortality 7
• Early and aggressive fluid resuscitation and early enteral nutrition are associated with lower rates of mortality and infectious complications 7
• The underlying etiology of acute pancreatitis should be sought in all patients, and risk-reduction strategies should be used during and after hospitalization for acute pancreatitis 7