Clinical Review

Fortnightly review : Acute pancreatitis

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7124.44 (Published 03 January 1998) Cite this as: BMJ 1998;316:44
  1. Klaus Mergener, fellow in gastroenterologya,
  2. John Baillie, associate professor of medicinea ([email protected])
  1. a Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
  1. Reprint requests: Dr Baillie
  • Accepted 24 July 1997

Introdution

More than a century after its comprehensive description by Reginald Fitz,1 acute pancreatitis remains a common disorder with potentially devastating consequences. Although most episodes are mild and self limited, up to a fifth of patients develop a severe attack that can be fatal.2 The overall mortality of acute pancreatitis remains 5-10%3 4 5 and may increase to 35% or higher if complications develop.5 The disease's course in a patient with acute pancreatitis is not always apparent at presentation; some patients get worse before they get better.

Methods

This overview was prepared from a continuous review of publications in gastroenterology and general medicine journals, supplemented by a formal Medline search and review of the most recent articles on pancreatitis. Reviews have been supplemented by original papers that include important recent developments. This review also reflects almost two decades of personal clinical experience and research related to pancreatitis by one of us (JB).

Definition

Acute pancreatitis is an acute inflammatory process of the pancreas that can involve peripancreatic tissues or remote organ systems, or both.6 It may occur as an isolated attack or recur in distinct episodes with reversion to normal histology between attacks. By definition, acute pancreatitis is reversible; it is distinguished from chronic pancreatitis by the absence of continuing inflammation, irreversible structural changes, and permanent impairment of exocrine and endocrine pancreatic function. As the diagnosis of acute pancreatitis is usually made on clinical grounds and pancreatic tissue is rarely available, it can be difficult to distinguish between acute and chronic pancreatitis in the individual case.

The most commonly used classification system for acute pancreatitis distinguishes between mild and severe disease.6 Severe disease is characterised by organ failure or local complications such as necrosis, pseudocysts, or fistulae. Scoring systems use prognostic signs to stratify patients and help …

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