Initial treatment of acute pancreatitis

-Early enteral nutrition, prophylactic antimicrobials, and regional arterial infusion-

Abstract

The initial treatment of patients with acute pancreatitis has undergone a paradigm shift in the last 10-15 years. Regarding enteral nutrition, long periods of fasting were recommended, but in recent years, guidelines in the world and Japan recommend early initiation of enteral nutrition. Evidence has accumulated that early enteral nutrition contributes to an improved prognosis. In addition, prophylactic administration of antibiotics has long been recommended for patients with severe pancreatitis, but the latest editions of guidelines for acute pancreatitis have deprecated the use of such agents. Furthermore, the guidelines do not recommend regional arterial infusion of protease inhibitors and antibiotics in the pancreas. As described above, the trend is changing drastically in Japan and the rest of the world. Therefore, all professionals involved in the initial treatment of acute pancreatitis must comply with the recommendations of the Japanese guidelines. In addition, the guidelines and their sponsoring academic societies must educate the public about the recommendations and repeat cross-sectional epidemiological studies.