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Pharmacologic management and prevention of acute pancreatitis

Machicado, Jorge D.a; Papachristou, Georgios I.b,c

Current Opinion in Gastroenterology: September 2019 - Volume 35 - Issue 5 - p 460–467
doi: 10.1097/MOG.0000000000000563
PANCREAS: Edited by Timothy B. Gardner
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Purpose of review The present article will focus in pharmacologic agents that have been studied to improve acute pancreatitis outcomes, and to prevent the disease at different levels.

Recent findings Too little and too much early fluid resuscitation can be harmful. The optimal volume, rate, and duration of intravenous fluid therapy is still unknown. Nonopioid analgesics should be the first line of analgesia in patients with acute pancreatitis. A few pharmacologic agents evaluated in acute pancreatitis have resulted in positive pilot trials; however, larger randomized clinical trials (RCTs) are needed before final conclusions. Statin use is associated with lower incidence of acute pancreatitis in the general population and ongoing studies are evaluating its preventive role in acute pancreatitis recurrences. The preventive role of rectal indomethacin in post-endoscopic retrograde cholangiopancreatography pancreatitis is indisputable, with subject selection and timing of administration requiring further investigation.

Summary There is still no proven effective disease-specific pharmacologic therapy that changes the natural history of acute pancreatitis. New therapeutic targets and pharmacologic agents are in the horizon. Careful refinement in study design is needed when planning future RCTs. There is also a need for drug development aiming at reducing the incidence of the disease and preventing its sequelae.

aDivision of Gastroenterology, Mayo Clinic Health System, Eau Claire, Wisconsin

bDivision of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

cDivision of Gastroenterology, Hepatology and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio, USA

Correspondence to Georgios I. Papachristou, MD, PhD, Professor of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Ohio State Wexner Medical Center, 395 W. Twelfth Ave Columbus, Ohio 43210, USA. Tel: +1 614 506 2134; e-mail: Papachristou.2@osu.edu

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