Acute pancreatitis: Translating early mechanisms to bedside management

Chiari H. Ueber Selbstverdauung des menschlichen Pankreas. Z Für Heilkd. 1896;17:69–96.

Google Scholar 

Mounzer R, Langmead CJ, Wu BU, et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology. 2012;142:1476–82. quiz e15–16.

PubMed  Google Scholar 

Christou CD, Tsoulfas G. Challenges involved in the application of artificial intelligence in gastroenterology: the race is on! World J Gastroenterol. 2023;29:6168–78.

CAS  PubMed  PubMed Central  Google Scholar 

Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.

PubMed  Google Scholar 

Knoph CS, Joseph N, Lucocq J, et al. No definite associations between opioid doses and severity of acute pancreatitis - results from a multicentre international prospective study. Pancreatology. 2025;25:12–9.

CAS  PubMed  Google Scholar 

de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or moderate fluid resuscitation in acute pancreatitis. N Engl J Med. 2022;387:989–1000.

CAS  PubMed  Google Scholar 

Wu BU, Hwang JQ, Gardner TH, et al. Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2011;9:710–7.e1.

PubMed  Google Scholar 

Guzmán-Calderón E, Diaz-Arocutipa C, Monge E. Lactate Ringer’s versus normal saline in the management of acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Dig Dis Sci. 2022;67:4131–9.

PubMed  Google Scholar 

Hong J, Li Q, Wang Y, et al. Comparison of fluid resuscitation with lactate Ringer’s versus normal saline in acute pancreatitis: an updated meta-analysis. Dig Dis Sci. 2024;69:262–74.

CAS  PubMed  Google Scholar 

Guilabert L, Cárdenas-Jaén K, Vaillo-Rocamora A, et al. Normal saline versus lactated Ringer’s solution for acute pancreatitis resuscitation, an open-label multicenter randomized controlled trial: the WATERLAND trial study protocol. Trials. 2024;25:699.

CAS  PubMed  PubMed Central  Google Scholar 

Bakker OJ, van Brunschot S, van Santvoort HC, et al. Early versus on-demand nasoenteric tube feeding in acute pancreatitis. N Engl J Med. 2014;371:1983–93.

CAS  PubMed  Google Scholar 

Moggia E, Koti R, Belgaumkar AP, et al. Pharmacological interventions for acute pancreatitis. Cochrane Database Syst Rev. 2017;4:CD011384.

PubMed  Google Scholar 

Tenner S, Vege SS, Sheth SG, et al. American College of Gastroenterology guidelines: management of acute pancreatitis. Am J Gastroenterol. 2024;119:419–37.

PubMed  Google Scholar 

Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association clinical practice update: management of pancreatic necrosis. Gastroenterology. 2020;158:67–75.e1.

CAS  PubMed  Google Scholar 

Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13 4 Suppl 2:e1–15.

Google Scholar 

Yan LH, Hu XH, Chen RX, et al. Plasmapheresis compared with conventional treatment for hypertriglyceridemia-induced acute pancreatitis: a systematic review and meta-analysis. J Clin Apheresis. 2023;38:4–15.

PubMed  Google Scholar 

Piplani S, Jain A, Singh K, et al. Efficacy and adverse effects of insulin versus plasmapheresis in patients with hypertriglyceridemia-3-induced acute pancreatitis: a systematic review and meta-analysis. Ann Gastroenterol. 2024;37:109–16.

PubMed  Google Scholar 

Cao L, Chen Y, Liu S, et al. Early plasmapheresis among patients with hypertriglyceridemia–associated acute pancreatitis. JAMA Netw Open. 2023;6:e2320802.

PubMed  PubMed Central  Google Scholar 

Joglekar K, Brannick B, Kadaria D, Sodhi A. Therapeutic plasmapheresis for hypertriglyceridemia-associated acute pancreatitis: case series and review of the literature. Ther Adv Endocrinol Metab. 2017;8:59–65.

PubMed  PubMed Central  Google Scholar 

Saluja A, Saluja M, Villa A, et al. Pancreatic duct obstruction in rabbits causes digestive zymogen and lysosomal enzyme colocalization. J Clin Invest. 1989;84:1260–6.

CAS  PubMed  PubMed Central  Google Scholar 

Gukovskaya AS, Gukovsky I. Autophagy and pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2012;303:G993–1003.

CAS  PubMed  PubMed Central  Google Scholar 

Biczo G, Vegh ET, Shalbueva N, et al. Mitochondrial dysfunction, through impaired autophagy, leads to endoplasmic reticulum stress, deregulated lipid metabolism, and pancreatitis in animal models. Gastroenterology. 2018;154:689–703.

CAS  PubMed  Google Scholar 

Sendler M, Weiss FU, Golchert J, et al. Cathepsin B-mediated activation of trypsinogen in endocytosing macrophages increases severity of pancreatitis in mice. Gastroenterology. 2018;154:704–18.e10.

CAS  PubMed  Google Scholar 

Dawra R, Sah RP, Dudeja V, et al. Intra-acinar trypsinogen activation mediates early stages of pancreatic injury but not inflammation in mice with acute pancreatitis. Gastroenterology. 2011;141:2210–7.e2.

CAS  PubMed  Google Scholar 

Talukdar R, Sareen A, Zhu H, et al. Release of cathepsin B in cytosol causes cell death in acute pancreatitis. Gastroenterology. 2016;151:747–58.e5.

CAS  PubMed  Google Scholar 

Lewarchik CM, Orabi AI, Jin S, et al. The ryanodine receptor is expressed in human pancreatic acinar cells and contributes to acinar cell injury. Am J Physiol Gastrointest Liver Physiol. 2014;307:G574–81.

CAS  PubMed  PubMed Central  Google Scholar 

Husain SZ, Orabi AI, Muili KA, et al. Ryanodine receptors contribute to bile acid-induced pathological calcium signaling and pancreatitis in mice. Am J Physiol Gastrointest Liver Physiol. 2012;302:G1423–33.

CAS  PubMed  PubMed Central  Google Scholar 

Waldron RT, Chen Y, Pham H, et al. The Orai Ca2+ channel inhibitor CM4620 targets both parenchymal and immune cells to reduce inflammation in experimental acute pancreatitis. J Physiol. 2019;597:3085–105.

CAS  PubMed  Google Scholar 

Jakkampudi A, Jangala R, Reddy R, et al. Acinar injury and early cytokine response in human acute biliary pancreatitis. Sci Rep. 2017;7:15276.

PubMed  PubMed Central  Google Scholar 

Chakraborty RK, Burns B. Systemic inflammatory response syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 March 18]. http://www.ncbi.nlm.nih.gov/books/NBK547669/

Jakkampudi A, Jangala R, Reddy BR, Mitnala S, Nageshwar Reddy D, Talukdar R. NF-κB in acute pancreatitis: mechanisms and therapeutic potential. Pancreatology. 2016;16:477–88.

CAS  PubMed  Google Scholar 

Jakkampudi A, Jangala R, Reddy R, et al. Fatty acid ethyl ester (FAEE) associated acute pancreatitis: an ex-vivo study using human pancreatic acini. Pancreatology. 2020;20:1620–30.

CAS  PubMed  Google Scholar 

Niu M, Zhang X, Wu Z, et al. Neutrophil-specific ORAI1 calcium channel inhibition reduces pancreatitis-associated acute lung injury. Funct Oxf Engl. 2024;5:zqad061.

Google Scholar 

Mole DJ, Olabi B, Robinson V, Garden OJ, Parks RW. Incidence of individual organ dysfunction in fatal acute pancreatitis: analysis of 1024 death records. HPB (Oxford). 2009;11:166–70.

PubMed  PubMed Central  Google Scholar 

Machicado JD, Gougol A, Tan X, et al. Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected. United European Gastroenterol J. 2021;9:139–49.

CAS  PubMed  PubMed Central  Google Scholar 

Prasada R, Muktesh G, Samanta J, et al. Natural history and profile of selective cytokines in patients of acute pancreatitis with acute kidney injury. Cytokine. 2020;133:155177.

CAS  PubMed  Google Scholar 

Siddappa PK, Kochhar R, Sarotra P, Medhi B, Jha V, Gupta V. Neutrophil gelatinase-associated lipocalin: an early biomarker for predicting acute kidney injury and severity in patients with acute pancreatitis. JGH Open. 2019;3:105–10.

PubMed  Google Scholar 

Siddall E, Khatri M, Radhakrishnan J. Capillary leak syndrome: etiologies, pathophysiology, and management. Kidney Int. 2017;92:37–46.

PubMed  Google Scholar 

Garg PK, Mahapatra SJ. Optimum fluid therapy in acute pancreatitis needs an alchemist. Gastroenterology. 2021;160:655–9.

PubMed  Google Scholar 

Martinon F, Burns K, Tschopp J. The inflammasome: a molecular platform triggering activation of inflammatory caspases and processing of proIL-beta. Mol Cell. 2002;10:417–26.

CAS  PubMed  Google Scholar 

Merza M, Hartman H, Rahman M, et al. Neutrophil extracellular traps induce trypsin activation, inflammation, and tissue damage in mice with severe acute pancreatitis. Gastroenterology. 2015;149:1920–31.e8.

Comments (0)

No login
gif