Review of Contemporary Diagnosis and Management
Douglas G. Adler, MD, FACG, AGAF, FASGE, and Ryan C. Van Woerkom, MD
Acute pancreatitis describes an acute inflammatory process of the pancreas that rapidly depletes
intravascular water and, if unchecked, promotes
regional inflammation. The severity spectrum of
acute pancreatitis ranges from mild interstitial
pancreatitis to a more severe form that includes
pancreatic necrosis, which is frequently associated
with concomitant multi-organ failure. Mild interstitial
pancreatitis has the highest prevalence, and acute
pancreatitis is typically rapid in onset. In 2005 and
2007, an estimated 230,000 patients were treated
for acute pancreatitis in hospitals in the United
States.1, 2 Recent studies have demonstrated an
increase in the incidence of acute pancreatitis,
and some have projected the incidence to be substantially higher than previously reported rates, although case-fatalities have remained stable since
1970.3 The increased frequency of acute pancreatitis may be due to the rising incidence of obesity,
a risk factor for the development of gallstones and,
by extension, gallstone pancreatitis, 4 although an
increase in surveillance bias cannot be excluded.
Acute pancreatitis confers a heavy financial
burden. A recent study estimated that the average cost per hospitalization for acute pancreatitis
is $9870.5 It is responsible for $2.2 billion in U.S.
health care expenditures annually. The average
length of hospital stay for a patient with acute pancreatitis is approximately 5 to 6 days; children had
shorter hospital stays and adults aged 45 to 64
years had hospital stays that were 1 day longer,
on average. 3, 6, 7 Acute pancreatitis may be accompanied by life-threatening complications
as well as significant morbidity and mortality.
This article reviews the diagnosis and management of patients with acute pancreatitis.
A revision of the Atlanta classification schema
for acute pancreatitis was recently published. 6 The
revised classification delineates 2 phases of acute
pancreatitis: early and late. Severity of pancreatitis
can be classified as mild, moderate, or severe.
Mild acute pancreatitis is not associated with
organ failure or local or systemic complications
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Gastroenterology Volume 14, Part 1 1