Update on the management of acute severe pancreatitis

Acute severe pancreatitis is an agressive disease with a mortality rate of up to 30 percent. In recent years therapy has shifted away from early surge ry to intensive medical care. This article focuses on several issues of the management of acute severe pa ncreatitis emphasising evidence from recent clinical trials and recommendat ions from recent consensus conferences. Since a correct assessment of the severity of the disease is mandatory as e arly as possible in the treatment, several multiple scoring factor systems and individual risk factors are explained. The indications and the optimal timing of ERCP are discussed. Prophylactic administration of antibiotics, i ntravenously or by means of a selective digestive decontamination scheme, s eems to be beneficial in decreasing morbidity but not mortality. Adequate n utritional support, preferably achieved by enteral feeding, is an important component in the supportive therapy. Protease inhibitors and anti-secretor y drugs have not proven to be of benefit in improving outcome. Immunomodula ting substances like platelet activating antagonists are promising but furt her studies are necessary to confirm the results of the early studies. Fina lly, indications for surgery are discussed.