CURRENT CONSERVATIVE TREATMENT OF ACUTE-PANCREATITIS - EVIDENCE FROM ANIMAL AND HUMAN STUDIES

Primary treatment of patients suffering from acute pancreatitis is con servative, irrespective of its etiology and initial severity. There is no effective specific therapy for treating the underlying disease pro cess. As a result, the current therapeutic approach involves the provi sion of supportive care, the elimination of causal (biliary tract) dis ease, and the treatment of complications. Since complications may deve lop at any time, patients with moderate or severe disease should be ad mitted to an intensive care unit for interdisciplinary assessment and constant observation of their clinical status and computed tomography findings. Basic therapy should include total fasting, replacement of d eficits in volume, electrolyte and albumin, as well as adequate analge sia. Depending on the patient's specific clinical condition, nasogastr ic suction, respiratory support, antibiotics, insulin and heparin may become necessary. The use of enzyme inhibitors and drugs capable of in hibiting pancreatic exocrine secretion has not proved effective in cli nical trials. The value of prostaglandins, non-steroidal anti-inflamma tory drugs and cholecystokinin receptor antagonists remains to be esta blished. Early endoscopic retrograde cholangiopancreatography should b e performed in patients with suspected underlying biliary disease. Pap illotomy should be carried out only when calculi are present in the co mmon bile duct. Local complications, such as pseudocysts and abscesses can often be treated by ultrasound- or CT-guided aspiration and drain age. However, when bacterial infection of pancreatic necrosis becomes evident, surgical intervention should be considered. Future evaluation of new therapeutic approaches by controlled studies needs to include a sufficient number of patients with severe acute pancreatitis.