The first 48 to 72 hours after a patient is hospitalized for acute pancreatitis (AP) are of critical importance. Early treatment decisions may have a significant impact on the course of disease and the length of hospitalization.
Clinical evidence challenging many long-held standard approaches has recently come to light, so the American Gastroenterological Association (AGA) recently updated its guidelines for the management of AP.
At times, the recommendations differ substantially from standard practice. For example, the AGA determined that when AP is caused by gallstones, surgical removal of the gallbladder should be performed before a patient is discharged rather than waiting. Likewise, the AGA now recommends that most patients be given solid foods within the first 24 hours, rather than having food withheld.
The guidelines, which were published in Gastroenterology in 2018, do not recommend preventive (prophylactic) antibiotics. Endoscopic retrograde cholangiopancreatography (ERCP) should be confined to patients whose AP is thought to be from an obstructed bile duct that has become infected (cholangitis).
Future studies may define in which patients antibiotics are appropriate, and what the optimal timing of ERCP might be in patients who could benefit from it. Further research is needed to create a comprehensive management strategy for alcohol-induced AP and other alcohol-related illnesses.