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An irritation of the pancreas that can cause it to stop working. It is most often caused by gallstones or alcohol abuse.

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Nutritional support, through the intestine (enteral) versus by injection (parenteral) for people with acute pancreatitis

The pancreas is a gland that lies behind the stomach. It produces enzymes that help digestion. Acute pancreatitis is an inflammation in the pancreas which causes severe pains in the stomach. Extra nutrition is needed to recover. However the pancreas needs rest in order to repair. Nutrition must therefore be given either by a tube into the intestines (enteral) or by injection (parenteral). This review found that patients with acute pancreatitis receiving enteral nutrition have fewer episodes of death, systemic infections, multiple organ failure and operative interventions. This data suggests that EN should be considered the standard of care for patients with acute pancreatitis requiring nutritional support.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Opioids for abdominal pain in acute pancreatitis

The pancreas is a gland behind the stomach and close to the first part of the small intestine. It produces digestive juices, amylase, secreted into the small intestine and releases hormones, insulin and glucagon, into the bloodstream. Acute pancreatitis refers to a sudden inflammation of the pancreas. It happens when digestive juices become active inside the pancreas, causing swelling, bleeding and damage to the pancreas and its blood vessels. It is a serious condition and can lead to further problems. Common symptoms are severe pain in the upper abdomen, nausea, and vomiting. Treatment is usually a few days in hospital for fluids, antibiotics, and medicines to relieve pain, delivered by drip.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Use of antibiotics to prevent infection of dead pancreatic tissue in acute pancreatitis

Acute pancreatitis is the inflammation of the pancreas, a serious emergency with no specific treatment. The pancreas, a digestive gland, can become inflamed for many reasons, but mainly as a complication from gallstones or excess alcohol intake. If severe, the pancreas may lose its blood supply, a complication called pancreatic necrosis that can be detected by computed tomography (CT) scanning.  Death can occur either early in the disease process in association with uncontrolled inflammatory responses, causing multiple organ‐system failure (MOSF), or late when the necrotic tissue becomes infected, which might necessitate major surgery to remove the infection, with the risk of death rising from 10% to over 40%. Antibiotics may prevent later infection and reduce the risk of death, but could also encourage bacterial antibiotic resistance and fungal infections. Controlled trials looking at the value of using prophylactic antibiotics have produced conflicting results.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Acute pancreatitis: Overview

Acute pancreatitis is an inflammation of the pancreas that typically causes very sudden stomach ache.The pain is usually so severe that most people go straight to a doctor. The most common causes are gallstones blocking the opening of the pancreas and excessive alcohol consumption.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 22, 2015

Blood and urine tests for the diagnosis of acute pancreatitis (sudden inflammation of pancreas)

The pancreas is an organ in the abdomen (tummy) that secretes several digestive enzymes (substances that break down the food we eat) into the pancreatic ductal system, which empties into the small bowel. The pancreas also contains the islets of Langerhans, which secrete several hormones such as insulin (which helps regulate blood sugar). Acute pancreatitis is sudden inflammation of the pancreas, which can lead to damage of the heart, lungs, and kidneys and cause them to fail. Acute pancreatitis usually manifests as upper abdominal pain radiating to the back. However, there are several potential causes of upper abdominal pain. It is important to determine if someone with abdominal pain has acute pancreatitis or another illness in order to start appropriate treatment. Blood tests such as serum amylase and serum lipase, as well as urine tests such as urinary trypsinogen‐2 and urinary amylase, can be used to determine if someone with abdominal pain has acute pancreatitis. It is usually the case that a patient is considered to have acute pancreatitis only when amylase or lipase levels are three times the upper limit of normal. With regard to urinary trypsinogen‐2, a level of more than 50 ng/mL of trypsinogen‐2 in the urine is considered an indication of acute pancreatitis. With regard to urinary amylase, there is no clear‐cut level beyond which someone with abdominal pain is considered to have acute pancreatitis. At present it is unclear whether these tests are equally effective or if one of the tests is better than the other in the diagnosis of acute pancreatitis in people with sudden‐onset abdominal pain. We determined to resolve this question by performing a literature search for studies reporting the accuracy of the above mentioned blood and urine tests. We included studies reported until 20 March 2017.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 21, 2017

Tube feeding in patients with acute pancreatitis

The intention of this systematic review was to show whether specific enteral nutrition (EN) formulations have any beneficial or harmful effects in the treatment of patients with acute pancreatitis (AP), and whether possible advantages and disadvantages are associated with certain types of EN in comparison with others. Enteral nutrition consists of artificial complete nutrition in liquid form that is absorbed through the intestines.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

How is acute pancreatitis treated?

Acute pancreatitis usually clears up within one to two weeks. Solid foods are usually not allowed for a while to avoid any additional strain on the pancreas. Supportive measures like infusion therapy to provide fluids and painkillers can help to relieve symptoms and prevent complications.The main signs of acute pancreatitis are sudden and severe pain in the upper abdomen, nausea and vomiting. It is usually caused by Gallstones blocking the opening in the pancreas or excessive consumption of alcohol.In 80 out of 100 cases the inflammation has either completely cleared up or shown significant improvement within one to two weeks. But sometimes it can become more severe and may even cause life-threatening complications, which is why pancreatitis is usually treated in the hospital.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 22, 2015

Endoscopy for the treatment of acute gallstone pancreatitis

Acute pancreatitis refers to sudden inflammation of the pancreas associated with severe abdominal pain. The most common cause is transient blockage of the pancreatic or bile duct (or both) by gallstones. Most attacks of acute pancreatitis are mild, and most patients recover uneventfully with medical management. However, a small proportion of patients have a more severe course requiring intensive medical management.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Medical treatment for people with acute pancreatitis (sudden inflammation of the pancreas)

The pancreas is an organ in the abdomen (tummy) that secretes several digestive enzymes (substances that enable and speed up chemical reactions in the body) into the pancreatic ductal system before it empties into the small bowel. It also contains the Islets of Langerhans, which secrete several hormones including insulin (helps regulate blood sugar). Acute pancreatitis is life‐threatening illness characterized by sudden inflammation of the pancreas, which can lead to failure of other organs, such as the lungs and kidneys. There is a lot of research into different medical treatments for the treatment of acute pancreatitis, but it is not clear what benefits each treatment has, or indeed if any medical treatment is beneficial apart from supportive treatment. This care includes body hydration and intensive care treatment for people with organ failure (to support the failing organs). We sought to resolve this issue by searching for existing studies on the topic. We included all randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) whose results were reported to 7 October 2016.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 21, 2017

Antioxidants to reduce pain in chronic pancreatitis

Chronic pancreatitis is a persistent inflammation of the pancreas that in the long run can cause irreparable damage. The major causes of chronic pancreatitis are genetics, alcohol toxicity and other conditions that might damage or obstruct the pancreas. This inflammation can cause pain that often is severe and leaves patients socially isolated and unable to perform their jobs. Unfortunately, treatment options are scarce, and often strong morphine‐like pain medications are needed. Patients might benefit from alternative medication without the adverse effects associated with morphine‐like medication. This review summarises the evidence from randomised trials on the effects of antioxidants in chronic pancreatitis. Antioxidants are substances that prevent damage to cells caused by toxic byproducts of oxygen in the body. Levels of these byproducts are increased in chronic pancreatitis. Antioxidants constitute a large group that contains many natural and man‐made products. Examples include vitamin C, vitamin E, flavonoids (present in tea and cocoa) and many specialised medications. We found 12 randomised trials on this topic. The quality of these trials was mixed, and many had small sample sizes and high rates of dropout. Evidence shows that antioxidants may reduce pain in patients with chronic pancreatitis, but the reported reduction in pain was small. Whether this small decrease really had an impact on patients' complaints is not clear. Given the methodological problems of these trials, a strong conclusion could not be drawn. Use of antioxidants resulted in adverse effects in about 16% of study participants. Most adverse effects were mild, such as headache, nausea and constipation. However, participants who developed these adverse effects tended to stop using antioxidant medication. Other outcomes important for decision making such as use of analgesics, rate of exacerbation of pancreatitis and quality of life, were not very well reported. Therefore, we were unable to reach conclusions on these outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Early or delayed removal of gallbladder by key‐hole surgery after a sudden episode of gallstone‐related pancreatitis

There is considerable controversy regarding how long one should wait after a sudden attack of acute gallstone pancreatitis before removing the gallbladder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Treatment methods for people with necrotising pancreatitis (pancreatic destruction due to inflammation of pancreas)

The pancreas is an organ in the abdomen (tummy) that secretes several digestive enzymes (substances that enable and speed up chemical reactions in the body) into the pancreatic ductal system, which empties into the small bowel. It also contains the Islets of Langerhans, which secrete several hormones including insulin (helps regulate blood sugar). Acute pancreatitis is sudden inflammation of the pancreas and can lead to destruction of the pancreas (pancreatic necrosis). Pancreatic necrosis can be infected or non‐infected (sterile). Pancreatic necrosis can lead to failure of other organs, such as the lungs and kidneys, and is a life‐threatening illness. The main treatments for pancreatic necrosis include removal of the dead tissue (debridement or necrosectomy), peritoneal lavage (washing dead tissue out of the abdomen, drainage (inserting a tube or 'drain' to drain out the fluid collection around the pancreas), or initial drainage followed by necrosectomy if necessary (called the minimally invasive 'step‐up' approach). The minimally invasive step‐up approach can be performed in different ways. For example, in video‐assisted minimally invasive step‐up approach, necrosectomy is performed after a period of drainage through a key‐hole operation; in the endoscopic minimally invasive step‐up approach, necrosectomy is performed with the help of an endoscope (instrument used to look inside the abdomen).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Duodenum‐preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis

The pancreas is an organ in the belly (abdomen) that secretes several digestive enzymes into the pancreatic ductal system (tubes that carry the pancreatic juice secreted by the pancreatic cells), which empties into the small bowel. It also comprises the Islets of Langerhans, which secrete several hormones including insulin (helps regulate blood sugar). Chronic pancreatitis is long‐standing and progressive inflammation of the pancreas resulting in destruction and replacement of pancreatic material (tissue) with fibrous tissue. This may lead to digestive enzyme deficiency (shortage) and insulin deficiency leading to diabetes (a lifelong condition that causes a person's blood sugar level to become too high). Alcohol is considered the main cause of acute pancreatitis. Chronic abdominal pain is the major symptom of chronic pancreatitis. The pain is usually in the upper abdomen and is described as deep, penetrating, and radiating to the back. Various theories exist about the reason for pain in chronic pancreatitis. One of the theories is that the disease process obstructs the pancreatic duct. So, surgery to remove the head of the pancreas (the part that is encircled by the duodenum) is recommended for some people with pain uncontrolled with medicines. Major complications of surgery include deaths (mortality) and re‐operations. However, it is unclear whether the duodenum should be excised (surgically removed) along with the head of the pancreas. Thus, we searched for existing studies on the topic. We included all randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) whose results were reported to 22 June 2015.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Endoscopic treatment of acute biliary pancreatitis: a systematic review

Bibliographic details: Chai C, Cao N, Li Q, Yang KH.  Endoscopic treatment of acute biliary pancreatitis: a systematic review. World Chinese Journal of Digestology 2010; 18(4): 404-408

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Adjuvant treatment of severe acute pancreatitis with rhubarb: a systematic review

Bibliographic details: Sheng YY, Zou XP, Yu CG, Lv Y, Zhang LL.  Adjuvant treatment of severe acute pancreatitis with rhubarb: a systematic review. World Chinese Journal of Digestology 2010; 18(7): 730-735

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

[Role of prophylactic antibiotics in the management of acute necrotizing pancreatitis: a meta-analysis]

Bibliographic details: Rao CY, Hu CL, Zhao XY.  [Role of prophylactic antibiotics in the management of acute necrotizing pancreatitis: a meta-analysis]. World Chinese Journal of Digestology 2012; 20(14): 1246-1251

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

[A meta-analysis on the timing of parenteral nutrition and enteral nutrition in acute pancreatitis]

Bibliographic details: Chen SM, Xiong GS, Wu SM.  [A meta-analysis on the timing of parenteral nutrition and enteral nutrition in acute pancreatitis]. Chinese Journal of Clinical Nutrition 2012; 20(6): 363-368

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Systematic evaluation of the therapeutic efficacy of Tongli Gongxia herbs on severe acute pancreatitis

Bibliographic details: Miao B, Cui NQ, Li ZL, Ma T, Zhao G, Wang X.  Systematic evaluation of the therapeutic efficacy of Tongli Gongxia herbs on severe acute pancreatitis. World Chinese Journal of Digestology 2009; 17(10): 1042-1047

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Nasogastric enteral nutrition for severe acute pancreatitis: meta-analysis of clinical trials

Bibliographic details: Yan ZF, Qi YM, Lu W, Xie Y.  Nasogastric enteral nutrition for severe acute pancreatitis: meta-analysis of clinical trials. Chinese Journal of Clinical Nutrition 2009; 17(5): 271-274

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications [Internet]

Alcohol is the most widely used psychotropic drug in the industrialised world; it has been used for thousands of years as a social lubricant and anxiolytic. In the UK, it is estimated that 24% of adult men and 13% of adult women drink in a hazardous or harmful way. Levels of hazardous and harmful drinking are lowest in the central and eastern regions of England (21–24% of men and 10–14% of women). They are highest in the north (26–28% of men, 16–18% of women). Hazardous and harmful drinking are commonly encountered amongst hospital attendees; 12% of emergency department attendances are directly related to alcohol whilst 20% of patients admitted to hospital for illnesses unrelated to alcohol are drinking at potentially hazardous levels. Continued hazardous and harmful drinking can result in dependence and tolerance with the consequence that an abrupt reduction in intake might result in development of a withdrawal syndrome. In addition, persistent drinking at hazardous and harmful levels can also result in damage to almost every organ or system of the body. Alcohol-attributable conditions include liver damage, pancreatitis and the Wernicke’s encephalopathy. Key areas in the investigation and management of these conditions are covered in this guideline.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: 2010
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