- Acute pancreatitis (AP) is an inflammatory condition of the pancreas that can cause local injury, systemic inflammatory response syndrome (SIRS) and organ failure.
- The incidence of AP ranges from 5–30 cases per 100,000, and there is evidence that the incidence is rising in recent years.
- The overall case fatality rate for AP is roughly 5% and is expectedly higher for more severe disease.
- The most common causes of AP remain gallstones and alcohol, which together comprise 80% of cases. The remainder of cases is due to less common causes, including drug reactions, pancreatic solid and cystic malignancies, and hypertriglyceridemia.
- Patients with AP frequently suffer from abdominal pain, nausea, and vomiting.
- The diagnosis of AP requires ≥2 of the following features:
- Characteristic abdominal pain
- Biochemical evidence of pancreatitis (i.e. amylase or lipase elevated >3 times the upper limit of normal) and/or
- Radiographic evidence of pancreatitis on cross-sectional imaging
GRADE Strength of Recommendations and Implications
|Grade||Quality of Evidence|
|High||We are very confident that the true effect lies close to that of the estimate of the effect.|
|Moderate||We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.|
|Low||Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect.|
|Very Low||We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.|
|Grade||Evidence of Recommendation|
|Strong||For the Patient||For the Clinician|
|Most individuals in this situation would want the recommended course of action and only a small proportion would not.||Most individuals in this situation would want the recommended course of action and only a small proportion would not.|
|The majority of individuals in this situation would want the suggested course of action, but many would not.||Different choices will be appropriate for different patients. Decision aids may well be useful in helping individuals making decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision.|
Summary of Recommendations of the AGA Clinical Guideline for the Initial Management of Acute Pancreatitis
|In patients with acute pancreatitis, AGA suggests using goal-directed therapy for fluid management. Comment: AGA makes no recommendation whether normal saline or ringer’s lactate is used.||Conditional||Very low|
|In patients with acute pancreatitis, AGA suggests against the use of hydroxyethyl starch (HES) fluids.||Conditional||Very low|
|In patients with predicted severe acute pancreatitis and necrotizing pancreatitis, AGA suggests against the use of prophylactic antibiotics.||Conditional||Low|
|In patients with acute biliary pancreatitis and no cholangitis, AGA suggests against the routine use of urgent ERCP.||Conditional||Low|
|In patients with acute pancreatitis, AGA recommends early (within 24 hours) oral feeding as tolerated rather than keeping the patient NPO.||Strong||Moderate|
|In patients with acute pancreatitis and inability to feed orally, AGA recommends enteral rather than parenteral nutrition.||Strong||Moderate|
|In patients with predicted severe or necrotizing pancreatitis requiring enteral tube feeding, AGA suggests either nasogastric or nasoenteral route.||Conditional||Low|
|In patients with acute biliary pancreatitis, AGA recommends cholecystectomy during the initial admission rather than following discharge.||Strong||Moderate|
|In patients with acute alcoholic pancreatitis, AGA recommends brief alcohol intervention during admission.||Strong||Moderate|