From the Guidelines
Pancreatitis treatment should prioritize a conservative and minimally invasive approach, focusing on managing symptoms and preventing complications while the pancreas heals, with antibiotics only used if infection is present, as recommended by the most recent and highest quality study 1.
Key Components of Treatment
- For mild acute pancreatitis, treatment typically involves:
- Fasting for 24-48 hours to rest the pancreas
- Pain management with medications like acetaminophen or opioids if needed
- Intravenous fluids to prevent dehydration
- For severe acute pancreatitis, hospitalization is necessary with more intensive supportive care, including:
- IV fluids
- Pain management
- Possibly nutritional support through a feeding tube or IV nutrition
Use of Antibiotics
- Antibiotics should only be used if infection is present, as prophylactic antibiotics are not associated with a significant decrease in mortality or morbidity 1
- Administration of antibiotics for prophylactic purposes in case of pancreatic necrosis without documented infection is conceptually wrong 1
Nutritional Support
- Enteral nutrition (oral, NG, or NJ) is recommended, with parenteral nutrition used if not tolerated 1
- Nutritional support should be individualized based on the patient's nutritional status and disease severity 1
Overall Approach
- The goal of treatment is to reduce inflammation, manage pain, and support the body while the pancreas recovers, as the organ needs time to heal from the inflammatory damage that characterizes this condition
- A conservative approach based on adequate resuscitation and physiological restoring procedures should be used, with surgery delayed in stable patients and reserved for cases of documented infection or other complications 1
From the Research
Pancreatitis Treatment Overview
- The treatment of acute pancreatitis involves several components, including fluid resuscitation and nutritional support 2, 3, 4, 5.
- The goal of fluid resuscitation is to restore blood volume and prevent organ failure, while nutritional support aims to provide the necessary nutrients for recovery 2, 4.
Fluid Resuscitation
- The optimal approach to fluid resuscitation in acute pancreatitis is still debated, with some studies suggesting that aggressive fluid resuscitation may increase the risk of fluid overload and mortality 6, 5.
- Moderate fluid resuscitation has been shown to be associated with lower mortality and fewer complications compared to aggressive fluid resuscitation 6, 5.
- The choice of resuscitative fluid and the clinical marker to target for resuscitation are still unclear and require further investigation 3.
Nutritional Support
- Enteral nutrition is preferred over parenteral nutrition in patients with acute pancreatitis, as it has been shown to have a beneficial influence on the outcome of the disease 2, 4.
- Early enteral nutrition, initiated within 48 hours of admission, has been associated with decreased hospital mortality and shorter length of stay 2, 4.
- The route of administration of enteral nutrition, whether through gastric or jejunal feeding, depends on digestive tolerance, and the potential role of soluble dietary fibre polydextrose as an agent to achieve energy goals is being explored 4.