Editorial
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Pathophysiol. Jun 15, 2012; 3(3): 60-70
Published online Jun 15, 2012. doi: 10.4291/wjgp.v3.i3.60
Update on pathogenesis and clinical management of acute pancreatitis
Dulce M Cruz-Santamaría, Carlos Taxonera, Manuel Giner
Dulce M Cruz-Santamaría, Carlos Taxonera, Department of Gastroenterology, Hospital Clínico San Carlos, Complutense University of Madrid, 28040 Madrid, Spain
Manuel Giner, Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, 28040 Madrid, Spain
Author contributions: All authors contributed equally to the conception and design of this article, drafting the manuscript and revising it critically for important intellectual content; finally, the version to be published was approved by the three authors.
Supported by Grant of the Spanish Government (FIS) PS09_01917
Correspondence to: Manuel Giner, MD, PhD, Professor of Surgery, Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, 28040 Madrid, Spain. manginer@med.ucm.es
Telephone: +34-913-941217 Fax: +34-913-303183
Received: October 31, 2011
Revised: May 22, 2012
Accepted: June 12, 2012
Published online: June 15, 2012
Abstract

Acute pancreatitis (AP), defined as the acute nonbacterial inflammatory condition of the pancreas, is derived from the early activation of digestive enzymes found inside the acinar cells, with variable compromise of the gland itself, nearby tissues and other organs. So, it is an event that begins with pancreatic injury, elicits an acute inflammatory response, encompasses a variety of complications and generally resolves over time. Different conditions are known to induce this disorder, although the innermost mechanisms and how they act to develop the disease are still unknown. We summarize some well established aspects. A phase sequence has been proposed: etiology factors generate other conditions inside acinar cells that favor the AP development with some systemic events; genetic factors could be involved as susceptibility and modifying elements. AP is a disease with extremely different clinical expressions. Most patients suffer a mild and limited disease, but about one fifth of cases develop multi organ failure, accompanied by high mortality. This great variability in presentation, clinical course and complications has given rise to the confusion related to AP related terminology. However, consensus meetings have provided uniform definitions, including the severity of the illness. The clinical management is mainly based on the disease´s severity and must be directed to correct the underlying predisposing factors and control the inflammatory process itself. The first step is to determine if it is mild or severe. We review the principal aspects to be considered in this treatment, as reflected in several clinical practice guidelines. For the last 25 years, there has been a global increase in incidence of AP, along with many advances in diagnosis and treatment. However, progress in knowledge of its pathogenesis is scarce.

Keywords: Pancreas; Pancreatitis; Pathogenesis; Treatment