New developments in understanding of pathophysiology, diagnosis and treatment of severe acute pancreatitis

Severe acute pancreatitis (SAP) remains being a clinical challenge, carrying significant burden of morbidity, mortality and patient related cost. In general, acute pancreatitis may vary in severity, from mild, self-limiting pancreatic inflammation to life-threatening pancreatic necrosis. Gallstone induced obstruction and alcohol abuse are the most common causes of pancreatitis in adults. Continuing interest in new biological markers and predictive models for timely identification of severe acute pancreatitis cases emphasizes clinical importance of early severity prediction. Among those markers, IL-6, IL-10, procalcitonin, and trypsinogen activation peptide are most likely to be used in clinical practice. Although all scoring systems had reliable accuracy in predicting pancreatitis severity and outcome, SOFA score performed. The treatment of mild disease is mainly supportive, while severe episodes require management by a multidisciplinary team including gastroenterologists, interventional radiologists, intensive care specialists, and surgeons. There are some unresolved issues pertinent to treatment, including indications for antibiotic prophylaxis, optimal route for nutritional support, selective intestinal decontamination and surgical management of pancreatic infection. The purpose of this review is to present advances in pathophysiology, diagnosis, and management of SAP.