Assessment and treatment of severe pancreatitis - Protease inhibitor

From the theoretical point of view, antiproteolytic therapy would seem to b e the rationale for acute pancreatitis management. Unfortunately, clinical human trials studying the role of antiproteases in the treatment of acute p ancreatitis differ in several respects in terms of their basic design. As a consequence, any form of homogeneous analysis of the reported data as a wh ole is impossible. Considering the data emerging from a meta-analysis of fi ve trials a rational use of antiproteases may result in a reduction of comp lications requiring surgery and of patient management costs only in selecte d cases, meaning by that severe and necrotic forms. As regards presumptive applications, over 400 patients were prospectively tested versus placebo in a double-blind trial with the aim of preventing acute pancreatitis after E RCP. The complication incidence was significantly lower among the pretreate d patients; anyway, also in this field of protease inhibitor clinical appli cation it is necessary to identify the patients with the greatest risk to d evelop post-ERCP acute pancreatitis. In conclusion, antiproteases can still play a role when given prophylactically or when used in the very early pha ses of the disease; moreover a 'multiple drugs approach' (including, for ex ample, suitable antibiotics) seems to represent nowadays the most modern an d rational treatment of acute pancreatitis.