Zerem E, Zerem D, Vila Š, Bajgorić S. Ascites in acute pancreatitis: A window into disease severity. World J Gastroenterol 2025; 31(43): 112797 [DOI: 10.3748/wjg.v31.i43.112797]
Corresponding Author of This Article
Enver Zerem, MD, Full Professor, Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Bistrik 7, Sarajevo 71000, Bosnia and Herzegovina. zerem@anubih.ba
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Gastroenterology & Hepatology
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Editorial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 21, 2025 (publication date) through Nov 20, 2025
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World Journal of Gastroenterology
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1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zerem E, Zerem D, Vila Š, Bajgorić S. Ascites in acute pancreatitis: A window into disease severity. World J Gastroenterol 2025; 31(43): 112797 [DOI: 10.3748/wjg.v31.i43.112797]
World J Gastroenterol. Nov 21, 2025; 31(43): 112797 Published online Nov 21, 2025. doi: 10.3748/wjg.v31.i43.112797
Ascites in acute pancreatitis: A window into disease severity
Enver Zerem, Dina Zerem, Šeila Vila, Sanja Bajgorić
Enver Zerem, Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo 71000, Bosnia and Herzegovina
Dina Zerem, Šeila Vila, Sanja Bajgorić, Department of Health Studies, University Dzemal Bijedić Mostar, Mostar 88000, Bosnia and Herzegovina
Co-first authors: Enver Zerem and Dina Zerem.
Author contributions: Zerem E contributed to the conception and design of the paper, writing of the paper, and final revision; Vila Š, Bajgorić S and Zerem D contributed to the literature search, writing of the paper, and final revision of the paper.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Enver Zerem, MD, Full Professor, Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Bistrik 7, Sarajevo 71000, Bosnia and Herzegovina. zerem@anubih.ba
Received: August 6, 2025 Revised: September 14, 2025 Accepted: October 17, 2025 Published online: November 21, 2025 Processing time: 106 Days and 9.5 Hours
Abstract
Acute pancreatitis (AP) is a complex and potentially life-threatening inflammatory condition with a highly variable clinical course, ranging from mild, self-limiting episodes to severe necrotizing forms. Among its common complications ascites has traditionally been viewed as a passive byproduct of peritoneal inflammation and enzymatic leakage with limited diagnostic or prognostic utility. However, growing evidence challenges this perspective, suggesting that ascitic fluid in AP represents a dynamic and clinically meaningful component of disease progression. In this editorial we reflected on the findings presented by Rao et al, who highlighted the diagnostic, prognostic, and therapeutic significance of ascitic fluid in AP. Easily accessible markers such as lactate dehydrogenase may provide early prognostic insight while emerging molecular biomarkers and cytokine profiles offer promise for more precise risk stratification and individualized therapy. We argue that the systematic evaluation of ascitic fluid should be integrated into the clinical management of moderate to severe AP. Incorporating ascites analysis into standard diagnostic protocols may enhance early risk assessment, inform therapeutic decisions, and ultimately improve patient outcomes. Ascitic fluid should be recognized as a clinically valuable marker and an important source of information in the evolving landscape of AP care.
Core Tip: There is increasing evidence that ascites in acute pancreatitis is more than an epiphenomenon. It reflects disease severity, provides actionable clinical information on inflammatory burden, vascular permeability, and risk of complications, and may serve as a target for personalized therapeutic strategies. Its biochemical and cellular composition can further support early risk stratification and guide treatment decisions.
