Materiały źródłowe

• #1 Global epidemiology and holistic prevention of pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6597260/

  Holistic prevention of pancreatitis refers to a comprehensive approach to its prevention. Prevention approaches are classically categorized as primary, secondary and tertiary in terms of the intervention time point and target population. In primary prevention, intervention is applied to the general population who do not have a disease of interest. These strategies typically aim to reduce disease incidence. Secondary prevention involves early identification of individuals with an existing disease of interest. The purpose of secondary prevention is to apply effective intervention early and reduce morbidity. Tertiary prevention is applied after a disease of interest is established, aiming at minimizing its sequelae and resulting burden. […] The concept of multi-level prevention has been known since the 1980s and has proven to be useful in reducing the burden of several diseases. However, the opportunity to apply this concept holistically to diseases of the pancreas has been overlooked as most early research in pancreatology was focused on a single aspect of prevention reducing the number of recurrences of pancreatitis. By aetiology, the preventive interventions included cholecystectomy for biliary pancreatitis, alcohol counselling for alcohol-induced pancreatitis and tight control of lipidaemia for hypertriglyceridaemia-induced pancreatitis. Here, we propose the holistic prevention of pancreatitis (HPP) framework, which is based on the above core principles of prevention applied, for the first time, broadly and holistically to pancreatitis.

• #2 Global epidemiology and holistic prevention of pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6597260/

  Opportunities for multi-level prevention are available for all elements of the HPP framework. Implementation of HPP requires the concerted contributions of health care professionals from various disciplines, including primary care physicians, gastroenterologists, surgeons, radiologists, pain specialists, endocrinologists, dietitians and public health specialists. […] Primary prevention strategies aim to reduce heavy alcohol use, smoking and obesity, while secondary prevention focuses on early detection and management of sequelae such as post-pancreatitis diabetes mellitus (PPDM) and exocrine pancreatic insufficiency (EPI). Tertiary prevention involves administration of preventative medications and regular follow-ups to manage complications. […] The holistic prevention of pancreatitis (HPP) concept postulates that primary, secondary and tertiary prevention strategies need to be systematically employed to lessen the effect of pancreatitis and its sequelae.

• #3 Global epidemiology and holistic prevention of pancreatitis | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-018-0087-5

  Knowledge of pancreatitis in the 20th century was shaped predominantly by animal data and clinical trials. […] Furthermore, the article introduces a framework for the holistic prevention of pancreatitis with a view to providing guidance on strategies and intervention objectives at primary, secondary and tertiary levels. […] The holistic prevention of pancreatitis (HPP) concept postulates that primary, secondary and tertiary prevention strategies need to be systematically employed to lessen the effect of pancreatitis and its sequelae.

• #4

  https://www.nhs.uk/conditions/acute-pancreatitis/prevention/

  Acute pancreatitis is often caused by gallstones or drinking too much alcohol. A healthy lifestyle can reduce your chances of developing the condition. […] The most effective way of preventing gallstones is by eating a balanced diet that includes at least 5 portions of fresh fruit and vegetables a day. […] You can reduce your risk of developing acute pancreatitis by cutting back on drinking alcohol. This helps to prevent your pancreas being damaged. […] Remember, if you’ve had acute pancreatitis caused by drinking too much alcohol, you should avoid it completely.

• #5 Pancreatitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/8103-pancreatitis

  Not all causes are preventable, but you can reduce your risk by moderating your alcohol consumption. You can reduce your risk of gallstones, the other leading cause, by reducing cholesterol. If you’ve had acute pancreatitis, you can help prevent it from happening again by quitting alcohol and smoking. If you’ve had gallstone pancreatitis, removing your gallbladder can prevent it from recurring.

• #6 5 Ways to Prevent Pancreatitis and Exocrine Pancreatic Insufficiency

  https://www.everydayhealth.com/hs/exocrine-pancreatic-insufficiency/prevent-pancreatitis-and-epi/

  There are ways you can protect your pancreas and reduce your risk for pancreatitis and other serious health problems, such as EPI. […] By drinking less (or not at all), you can help protect your pancreas from the toxic effects of alcohol and reduce your risk for pancreatitis. […] To reduce your risk for gallstones, eat a heart-healthy diet that includes whole grains and a variety of fresh fruits and vegetables. […] People who are overweight are more likely to develop gallstones, which leads to a greater risk for acute pancreatitis. […] When you go into crash-diet mode, prompting quick weight loss, your liver ramps up cholesterol production in response, which increases your risk for gallstones. […] A review of studies published in December 2019 in the journal Pancreatology found that adults who smoked were 1.5 times more likely to develop pancreatitis than nonsmokers. […] If you have risk factors for pancreatitis, make the appropriate lifestyle changes to prevent it.

• #7 Pancreatitis – What causes pancreatitis? | familydoctor.org

  https://familydoctor.org/condition/pancreatitis/

  You can’t prevent pancreatitis, but there are steps you can take to reduce the risk that you will develop it. These include: […] Maintain a healthy lifestyle or lose weight, if needed. By keeping your body at a healthy weight, you can make your pancreas work better and reduce some risk factors for pancreatitis. These include gallstones, obesity, and diabetes. Eat a balanced, low-fat diet and exercise regularly. […] Avoid alcohol. Heavy alcohol use is one of the leading causes of both acute and chronic pancreatitis. Talk to your doctor if you need help to stop drinking. […] Don’t smoke. Smoking is a risk factor for pancreatitis. Your risk goes up even more if you smoke and drink alcohol. Talk to your doctor if you need help to stop smoking.

• #8 Acute Pancreatitis – Symptoms, Causes , Treatment & Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact Nu

  https://www.pacehospital.com/acute-pancreatitis-symptoms-causes-types-treatment-prevention

  Acute pancreatitis and recurrent episodes can be prevented by taking the following precautions: […] Reducing alcohol consumption […] Maintaining a healthy weight and avoiding obesity […] Quitting smoking […] Early Gallstone Treatment […] Dietary Adjustments (A diet low in fat) […] Acute pancreatitis can be prevented by limiting alcohol consumption, maintaining a healthy weight, consuming a balanced diet, quitting smoking, and managing conditions like high cholesterol and gallstones.

• #9 Lifestyle Medicine for the Prevention and Treatment of Pancreatitis and Pancreatic Cancer

  https://www.mdpi.com/2075-4418/14/6/614

  The incidence of pancreatitis and pancreatic cancer is on the upswing in the USA. […] Increasing evidence underscores the importance of a healthy lifestyle in preventing and managing these conditions. […] Lifestyle medicine is critical in understanding, preventing, and treating pancreatitis and pancreatic cancer. By focusing on the six pillars of lifestyle medicine, individuals can adopt healthy behaviors that promote their overall well-being and potentially reduce the risk or impact of these conditions. […] Lifestyle modifications, including weight reduction, exercise, and dietary changes, can improve pancreatic fatty infiltration associated with metabolic syndrome. […] Therefore, increasing hydration and maintaining sufficient fluid intake to keep urine clear or light yellow may help prevent the recurrence of or minimize the intensity/frequency of idiopathic pancreatitis in high-risk patients.

• #10 Acute Pancreatitis Treatment & Management: Approach Considerations, Initial Supportive Care, Antibiotic Therapy

  https://emedicine.medscape.com/article/181364-treatment

  When the cause of pancreatitis can be determined, prevention depends on stopping the etiologic agent from causing subsequent episodes. […] In patients with documented gallstone pancreatitis and probably in those with idiopathic recurrent pancreatitis as well, cholecystectomy is required. […] In patients who abuse alcohol, a dedicated person (eg, physician, psychologist, addiction counselor) who can help the patient overcome the addiction to alcohol is required. […] When an uncommon cause of pancreatitis is identified, the path of prevention is specific to the etiology.

• #11 Pancreatitis: Symptoms, Causes, Diagnosis, Treatments, Tests

  https://www.webmd.com/digestive-disorders/digestive-diseases-pancreatitis

  How Do You Prevent Pancreatitis? […] Because many cases of pancreatitis are caused by alcohol abuse, prevention often focuses on limiting how much you drink or not drinking at all. If your drinking is a concern, talk to your doctor or health care professional about an alcohol treatment center. A support group such as Alcoholics Anonymous could also help. […] Other things you can do to reduce your chances of having the condition include stopping smoking, following your doctor’s and dietitian’s advice about your diet, and taking any medications your doctor prescribes. […] […] […] The disease is highly treatable, but complications can be life-threatening, so early diagnosis and treatment are critical for recovery. Alcohol use is one of the main risk factors, so limiting how much you drink, or not drinking at all, is key to preventing it.

• #12 Acute Pancreatitis Therapy and Prevention 急性胰腺炎治療及預防 | 衛教單張 – China Medical University Hospital

  https://www.cmuh.cmu.edu.tw/HealthEdus/Detail_EN?no=6978

  Once acute pancreatitis is diagnosed, early treatment should be provided to patients, including fluid resuscitation, pain relief, and nutritional support. […] Research reveals that the promotional education carried on patients with alcohol-induced pancreatitis in every 6 months can reduce the number of recurrence for pancreatitis in 2 years. […] Patients with minor biliary pancreatitis should receive cholecystectomy upon administration to hospital. […] For patients with severe condition, cholecystectomy should be postponed after the full absorption of inflammation and fluid to avoid infection. […] Patients who could not receive surgery shall receive endoscopic papillotomy to lower the recurrence rate since it could facilitate the gallstones with unobstructed discharge. […] Preventive stent placement and pre-incision are often recommended for the prevention of post-ERCP pancreatitis.

• #13 A Review of Prevention of Post-ERCP Pancreatitis – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2018/a-review-of-prevention-of-post-ercp-pancreatitis/

  Post-ERCP pancreatitis (PEP) is the most common complication of ERCP and can lead to significant morbidity as well as occasional mortality. […] In high-risk patients, several measures can be undertaken to limit the risk of PEP, including administration of rectal nonsteroidal anti-inflammatory drugs, prophylactic placement of pancreatic duct stents, and liberal administration of lactated Ringer solution. […] Evidence has been growing in recent years regarding the use of pancreatic duct stent placement to prevent the development of PEP. Pancreatic duct stent placement is thought to allow for reduction in pressure within the pancreatic duct. […] Despite substantial evidence supporting prophylactic pancreatic duct stent placement, there are several limitations to consider. […] Rectal NSAIDs, prophylactic pancreatic duct stent placement, and liberal administration of LR solution should be considered in high-risk patients.

• #14 Update on the Management of Acute Pancreatitis and Its Complications | MDedge

  https://mdedge.com/gihepnews/article/156078/update-management-acute-pancreatitis-and-its-complications

  Prevention […] As with any disorder, management starts with prevention. Primary prevention of AP has only been well studied in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is the most common and arguably the most dreaded complication of ERCP with reported incidence of approximately 10%. Several medications and endoscopic interventions have been assessed for the prevention of PEP. Of these, placement of prophylactic pancreatic duct stents and administration of rectal nonsteroidal anti-inflammatory drugs, especially indomethacin, have shown significant benefit in reducing risk for PEP. It is unclear at this point whether rectal indomethacin alone (without pancreatic duct stenting) is sufficient in patients at high risk for PEP. The SVI (Stent Vs. Indomethacin) trial, an ongoing multicenter randomized controlled trial, aims to answer this specific question.

• #15

  https://www.asge.org/home/resources/key-resources/blog/view/trainee-advisor/2025/03/19/prophylaxis-and-management-of-acute-pancreatitis–recent-research

  Prophylactic Pancreatic Stent to Reduce Post-ERCP Pancreatitis: In a multicenter randomized controlled study, Elmunzer et al. evaluated the efficacy of rectal indomethacin alone versus rectal indomethacin combined with prophylactic pancreatic stent placement in reducing post-ERCP pancreatitis. A total of 1,950 patients were randomized to receive either rectal indomethacin alone or in combination with a pancreatic stent. The incidence of post-ERCP pancreatitis was significantly lower in the group that received both rectal indomethacin and a pancreatic stent. […] Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis.

• #16 Intravenous lactated Ringer’s solution alone and in combination with NSAIDs in prevention of post-ERCP acute pancreatitis: an updated systematic review

  https://www.explorationpub.com/Journals/em/Article/1001247

  Post-endoscopic retrograde cholangiopancreatography acute pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Studies have shown that periprocedural administration of lactated Ringers (LR) solution may prevent PEP by multiple mechanisms. To assess the evidence for periprocedural aggressive hydration with LR alone or in combination with non-steroidal anti-inflammatory drugs (NSAIDs) as a preventive measure for post-ERCP pancreatitis, an updated systematic review was conducted. […] Aggressive hydration with LR is an effective alternative prophylactic strategy to NSAIDs for PEP. Further studies are needed to ascertain whether prophylaxis with a combination of aggressive hydration with LR and NSAIDs is more effective than prophylaxis with NSAIDs alone.

• #17 Intravenous lactated Ringer’s solution alone and in combination with NSAIDs in prevention of post-ERCP acute pancreatitis: an updated systematic review

  https://www.explorationpub.com/Journals/em/Article/1001247

  Peri-procedural hydration with lactated Ringers (LR) solution is a more recent and promising prophylactic strategy for PEP. The rationale for using LR solution in the prophylaxis of PEP is based on published evidence of improved outcomes in patients with severe acute pancreatitis treated aggressively with early administration of LR solution. […] Given the existing controversies on drug prophylaxis, an updated systematic review of available studies was conducted to assess the impact of aggressive LR hydration on PEP prophylaxis. […] The first prospective multicenter RCT on the efficacy of aggressive peri-procedural hydration with LR in reducing the incidence of PEP was published by Buxbaum et al. […] Meta-analyses have confirmed the protective role of aggressive hydration in the prophylaxis of post-ERCP acute pancreatitis and hyperamylasemia, even in low-risk patients.

• #18 Nafamostat for Prophylaxis against Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Compared with Gabexate

  https://www.gutnliver.org/journal/view.html?volume=3&number=3&spage=205

  Nafamostat for Prophylaxis against Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Compared with Gabexate […] The protease inhibitors, nafamostat and gabexate, have been used to prevent pancreatitis related to endoscopic retrograde cholangiopancreatography (ERCP). In vitro, nafamostat inhibits the pancreatic protease activities 10-100 times more potently than gabexate. We evaluated the efficacy of nafamostat for prophylaxis against post-ERCP pancreatitis in comparison with gabexate. […] Five hundred patients (208 patients in the nafamostat-treated group and 292 in the gabexate-treated group) were analyzed retrospectively after selective exclusion. The incidences of pancreatitis and hyperamylasemia after the ERCP were compared between the nafamostat and gabexate groups.

• #19 Nafamostat for Prophylaxis against Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Compared with Gabexate

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=98&vmd=Full

  The protease inhibitors, nafamostat and gabexate, have been used to prevent pancreatitis related to endoscopic retrograde cholangiopancreatography (ERCP). In vitro, nafamostat inhibits the pancreatic protease activities 10-100 times more potently than gabexate. We evaluated the efficacy of nafamostat for prophylaxis against post-ERCP pancreatitis in comparison with gabexate. […] Several attempts have been made to minimize the occurrence and severity of PEP; identifying high-risk patients, developing less traumatic endoscopic interventions to limit pancreatic injury, and finding effective pharmacologic agents to administer prophylactically before ERCP. The efficacy of such agents (somatostatin, octreotide, diclofenac, indomethacin, and gabexate mesylate) to reduce the risk of PEP had been studied extensively.

• #20 Acute pancreatitis secondary prevention – wikidoc

  https://www.wikidoc.org/index.php/Acute_pancreatitis_secondary_prevention

  The secondary prevention of acute pancreatitis primarily focuses on prevention of recurrence. The secondary prevention of acute pancreatitis varies according to the underlying etiology of the primary event. Cholecystectomy, alcohol abstinence, withdrawal of aggravating medications, weight control, and control of hyperlipidemia are among the most common methods of preventing recurrence of acute pancreatitis. […] A delay of cholecystectomy for more than a few weeks after acute pancreatitis puts the patient at a high risk for relapse. There is a correlation between delay of cholecystectomy and rate of recurrence. For patients in which cholecystectomy cannot be safely performed, endoscopic biliary sphincterotomy may prevent recurrence of pancreatitis. […] Patients who developed acute pancreatitis secondary to alcohol abuse are at high risk of recurrent pancreatitis or even chronic pancreatitis. ~50% of patients with alcoholic pancreatitis suffer from recurrence if they continue abusing alcohol. The risk is significantly reduced after abstaining from alcohol. A focused approach directed at alcohol and smoking cessation should be taken with the patient. […] Control of hypertriglyceridemia is effective in preventing recurrence of pancreatitis. Repeated measurements of serum triglycerides after discharge may be beneficial.

• #21 How to Lower Your Risk of Future Pancreatitis Attacks

  https://health.clevelandclinic.org/pancreatitis-how-to-lower-your-risk-of-future-attacks

  Stopping future pancreatitis attacks are possible. To start on a healthy journey, its important to make some behavioral and lifestyle changes. […] Successful management will involve multi-specialist care, including behavioral and lifestyle modification. […] If you keep having pancreatitis flare-ups, it can eventually lead to pancreatic scarring, so its crucial to make these needed changes. Do what you can to lower these risk factors: […] Heavy drinking. Excessive alcohol intake causes up to 70% of chronic pancreatitis cases, and nearly half of acute pancreatitis, so it makes sense to stop drinking alcohol. […] Smoking. It can make your outcomes worse, make the disease (chronic pancreatitis) progress faster and increase your risk of pancreatic cancer. […] Poor diet. Avoid high-fat foods, especially fried foods that can put a load on your digestive system. Instead, focus on eating a low-fat, high-protein diet that is rich in vitamins and nutrients. Patients with chronic pancreatitis often benefit from the institution of medium-chain triglyceride (MCT) oil in their diet. You may also consider taking artificial digestive enzymes, which help your body break down food and absorb nutrients and vitamins. Consult with your doctor about if artificial digestive enzymes would be a good idea to take.

• #22 Chronic Pancreatitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/chronic-pancreatitis.html

  The best way to prevent chronic pancreatitis is to drink only in moderation or not at all. Moderate alcohol drinking is considered to be no more than 1 drink per day for women and 2 drinks per day for men. Quitting smoking is also very helpful. It eases pain and swelling. […] If you have been diagnosed with chronic pancreatitis, your healthcare provider may suggest lifestyle changes. […] Don’t drink alcoholic drinks. […] Don’t smoke.

• #23 Pancreatitis Diet: Foods to Eat and Avoid

  https://www.healthline.com/health/pancreatitis-diet

  Researchers have identified certain foods you can eat to protect and even help heal your pancreas. These include starchy vegetables, lean meats, and low-fiber vegetables and fruits. Changing how often you eat can also be beneficial. […] During an episode of acute pancreatitis, the first step of treatment often involves avoiding all food and drink. Your health care team may need to administer a special liquid diet, IV fluids, or enteral feeding (a feeding tube). […] After acute pancreatitis, your doctor will usually recommend reducing your fat intake until your symptoms improve. This can involve limiting high-fat foods such as: fatty meats, organ meats, fried foods, fries and potato chips, oily sauces and spreads, such as mayonnaise, vegetable oils, margarine, and butter, full-fat dairy, pastries, cakes, and cookies, ice cream.

• #24 Recurrent acute pancreatitis prevention by the elimination of alcohol and cigarette smoking (REAPPEAR): protocol of a randomised controlled trial and a cohort study | BMJ Open

  https://bmjopen.bmj.com/content/12/1/e050821

  Acute recurrent pancreatitis (ARP) due to alcohol and/or tobacco abuse is a preventable disease which lowers quality of life and can lead to chronic pancreatitis. The REAPPEAR study aims to investigate whether a combined patient education and cessation programme for smoking and alcohol prevents ARP. […] The study could provide a cost-effective and easy-to-use preventive method, reducing the recurrence rate of alcoholic acute pancreatitis. […] Despite the importance and potentially preventable nature of alcoholic ARP, preventive efforts are still scarce. […] A pivotal study from Nikkola et al found that abstinent patients experienced no ARPs during a 9-year follow-up period. […] The REAPPEAR study aims to fill these gaps and provide specialists and primary care physicians with valuable information on the importance of alcohol and smoking cessation in AP and ARP. Furthermore, the feasibility, efficacy and cost-effectiveness of an intervention programme will be tested in this population to provide basis for large-scale intervention in alcohol-induced pancreatitis.

• #25 Antibiotic Prophylaxis for Severe Acute Pancreatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p49.html

  Does antibiotic prophylaxis decrease mortality in hospitalized patients with severe acute pancreatitis? […] No, antibiotic prophylaxis does not decrease mortality in patients with severe acute pancreatitis, defined as pancreatitis associated with pancreatic necrosis. (Strength of Recommendation: A, based on meta-analyses of randomized controlled trials [RCTs] and a single RCT.) […] This meta-analysis also showed no mortality benefit from antibiotic prophylaxis (N = 439; RR = 0.76; 95% CI, 0.49 to 1.2). […] Antibiotic prophylaxis is not protective in severe acute pancreatitis: a systematic review and meta-analysis.

• #26 Assessment of prophylactic antibiotics administration for acute pancreatitis: a meta-analysis of randomized controlled trials

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7028185/

  Recent evidence has shown that prophylactic antibiotic treatment in patients with acute pancreatitis is not associated with a significant decrease in mortality or morbidity. […] The use and efficacy of prophylactic antibiotic treatment in acute pancreatitis remain controversial. […] This meta-analysis was conducted to assess whether antibiotic prophylaxis is beneficial in patients with acute pancreatitis. […] Prophylactic antibiotics can reduce the incidence of non-pancreatic infection in patients with AP. […] Although several clinical trials and guidelines point out that prophylactic antibiotics are not beneficial in preventing infected necrosis and reducing the incidence of complications and death, some physicians still choose to administer prophylactic antibiotics to patients with AP.

• #27 2019 WSES guidelines for the management of severe acute pancreatitis | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0247-0

  Recent evidences have shown that prophylactic antibiotics in patients with acute pancreatitis are not associated with a significant decrease in mortality or morbidity. Thus, routine prophylactic antibiotics are no longer recommended for all patients with acute pancreatitis (1A). […] Antibiotics are always recommended to treat infected severe acute pancreatitis. However the diagnosis is challenging due to the clinical picture that cannot be distinguished from other infectious complications or from the inflammatory status caused by acute pancreatitis (2A). […] Serum measurements of procalcitonin (PCT) may be valuable in predicting the risk of developing infected pancreatic necrosis (1B).

• #28 Prophylaxis and treatment with antibiotics or probiotics in acute pancreatitis | Pancreapedia

  https://pancreapedia.org/reviews/prophylaxis-and-treatment-with-antibiotics-or-probiotics-in-acute-pancreatitis

  Early in the disease course of necrotizing pancreatitis two treatment strategies have been suggested to prevent secondary infection of peripancreatic collections and pancreas necrosis: […] Prophylactic administration of antibiotics […] Probiotic prophylaxis is not recommended for the prevention of infectious complications in acute pancreatitis. (GRADE 1B, strong agreement) […] Intravenous antibiotic prophylaxis is not recommended for the prevention of infectious complications in acute pancreatitis. (GRADE 1B, strong agreement)

• #29 Antibiotic Utilization in Acute Pancreatitis: A Narrative Review

  https://www.mdpi.com/2079-6382/12/7/1120

  In summary, recent studies confirm that antibiotic prophylaxis in the setting of SAP is not associated with a statistically significant reduction in mortality or incidence of infected pancreatic necrosis (IPN), with variable reductions in the incidence of nonpancreatic infections. […] Despite its possible clinical benefits, antibiotic prophylaxis is also correlated with risks, including increased prevalence of multi-drug-resistant bacteria and incidence of fungal infection, among other effects. […] Although antibiotic prophylaxis is not recommended by international guidelines, the clinical use of prophylactic antibiotics in SAP has become widespread; a retrospective study conducted in the United Kingdom in 2018 showed how the rate of antibiotic use in AP was about 62%, while a global systematic overview of reports that included data on the use of antibiotics showed a use rate of 41–88%. Based on these data, greater adherence to guidelines should be recommended in order to limit the effects of the side effects just described in the face of benefits that are not evident to date based on the most recent evidence.

• #30 Acute Pancreatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1101/p632.html

  In severe cases involving greater than 30% necrosis, antibiotic prophylaxis with imipenem/cilastatin decreases the risk of pancreatic infection. […] Prophylactic antibiotics should be used only when there is greater than 30% necrosis in the pancreas. […] Approximately one-third of patients with necrotic pancreatitis develop infections. […] The American Gastroenterological Association guidelines recommend restricting the use of prophylactic antibiotics to patients with necrosis involving greater than 30% of the pancreas, whereas the ACG recommends routine prophylaxis for patients with extrapancreatic infection but not those with severe acute pancreatitis or sterile necrosis.

• #31 Timing of Antibiotic Prophylaxis in Acute Pancreatitislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/jg200609010000001/2006/09/01/timing-antibiotic-prophylaxis-acute-pancreatitis

  Immediate antibiotic prophylaxis is recommended for patients with diagnosed pancreatic necroses (J Gastroenterol Hepatol 2002; 17(suppl):S15). […] Patients should be given prophylactic antibiotics once severe pancreatitis is clinically suspected; however, antibiotics should be continued or stopped as soon as possible, based on CECT scan findings.

• #32 Assessment of prophylactic antibiotics administration for acute pancreatitis: a meta-analysis of randomized controlled trials

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7028185/

  The results of several previously published meta-analyses have also differed. […] Our meta-analysis not only assessed the effects of the prophylactic use of antibiotics on mortality and infected pancreatic necrosis but also on pneumonia, UTI, and fungal infection, among others. […] However, the use of antibiotics was associated with a statistically significant reduction in the incidence of non-pancreatic infections. […] According to the results of our meta-analysis, antibiotic prophylaxis did not reduce the incidence of infected pancreatic necrosis and surgical intervention. […] Therefore, the present study findings showed no statistically significant benefit of prophylactic antibiotic use in AP.

• #33 Antibiotic Prophylaxis in Severe Acute Pancreatitis: Do We Need M

  https://www.primescholars.com/articles/antibiotic-prophylaxis-in-severe-acute-pancreatitis-do-we-need-more-metaanalytic-studies-98167.html

  Overall, there was no protective effect of antibiotic treatment with respect to mortality. With respect to morbidity, antibiotic prophylaxis did not protect against infected necrosis or surgical intervention. […] There was, however, an apparent benefit as regards nonpancreatic infections, with a relative risk reduction of 40%, absolute risk reduction of 15%, and number needed to treat of 7. […] In fact, results from a recent randomized trial, showing a significant reduction in extrapancreatic sepsis by starting antibiotic prophylaxis on admission to hospital, support this hypothesis. […] In conclusion, we do not need more meta-analytic studies on this topic; on the contrary, additional and well-carried out studies are required to explore the benefits of antibiotic prophylaxis in severe acute pancreatitis, also taking into account the adverse effects, the effects of the varying duration of the therapy, and whether the outcome of the infection is related to the etiology.

• #34 Effect of early antibiotic treatment strategy on prognosis of acute pancreatitis | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-023-03070-1

  There is currently no consensus on the optimal timing and duration of anti-infective treatment for AP, and the threat of multidrug-resistant bacteria further complicates treatment decisions. […] Our study showed that early use of carbapenems and third-generation cephalosporin in patients with biliary SAP and MSAP, respectively, improved patient prognosis. Early application of quinolone antibiotics in patients with biliary MAP shortens the length of hospital stay. Early application of antibiotics in patients with non-biliary AP did not significantly improve prognosis. Early antibiotic treatment strategies for AP should be managed according to disease etiology and severity.

• #35

  https://journals.lww.com/ajg/fulltext/2016/10001/chemical_prophylaxis_to_prevent_dvt_in_patients.114.aspx

  Hemorrhagic complications in pancreatitis occur in 1.2%-14.5% of patients. […] Splanchnic venous thrombosis occurrence in 1.8% of patients with pancreatitis. […] Our study is the first of its kind to evaluate risk of bleeding/thrombosis with DVT prophylaxis but does not show an increased risk.

• #36 Probiotic prophylaxis in patients with predicted severe acute pancreatitis (PROPATRIA): design and rationale of a double-blind, placebo-controlled randomised multicenter trial [ISRCTN38327949] | springermedizin.de

  https://www.springermedizin.de/probiotic-prophylaxis-in-patients-with-predicted-severe-acute-pa/9512772

  Infectious complications are the major cause of death in acute pancreatitis. Goal of this study is to determine whether selected probiotics are capable of preventing infectious complications without the disadvantages of antibiotic prophylaxis; antibiotic resistance and fungal overgrowth. […] The study objective is to show that probiotics are effective in reducing the number of infectious complications during the course of acute pancreatitis. […] The primary endpoint is the total numbers of infectious complications during the hospital stay for acute pancreatitis. […] The PROPATRIA study is aimed to show a reduction in infectious complications due to early enteral use of multispecies probiotics in severe acute pancreatitis. […] It is the goal of the present study to investigate the use of prophylactic probiotics as an alternative strategy.

• #37 Probiotic prophylaxis in patients with predicted severe acute pancreatitis (PROPATRIA): design and rationale of a double-blind, placebo-controlled randomised multicenter trial [ISRCTN38327949] | springermedizin.de

  https://www.springermedizin.de/probiotic-prophylaxis-in-patients-with-predicted-severe-acute-pa/9512772

  Probiotics are living micro-organisms that upon oral delivery exert a range of health promoting properties. […] The maximum of 72 hours between onset of symptoms and start of treatment was decided upon, based on the consideration that probiotics are expected to prevent infection of pancreatic necrosis. Therefore the probiotics should be administered prior to the stage that bacterial overgrowth starts and intraluminal bacteria migrate across the mucosal barrier. […] The primary outcome parameter 'total of infectious complications’, was chosen because it was shown in previous trials that also the number of pulmonary and urinary tract infections can be reduced by probiotics. […] PROPATRIA is a double-blind, placebo-controlled randomised multicenter trial that aims to show a reduction in infectious complications by the enteral use of a multispecies probiotics preparation in patients with predicted severe acute pancreatitis.

• #38 No evidence for the benefit of PPIs in the treatment of acute pancreatitis: a systematic review and meta-analysis | Scientific Reports

  https://www.nature.com/articles/s41598-023-29939-5

  Although current guidelines do not recommend the use of proton pump inhibitors (PPIs) in the standard of care of acute pancreatitis (AP), they are often prescribed in clinical practice, mainly for ulcer stress prophylaxis. […] The use of PPIs for the treatment of AP can be considered as an off-label indication; however, the usual indications of PPIs may coincide with AP treatment. […] The prophylactic use of PPIs for stress ulcer prophylaxis in individuals with AP is an off-label indication. […] Even though PPIs are widely used during the treatment of AP, this is the first meta-analysis assessing their association with various AP related clinical outcomes. […] Our meta-analysis pointed out that even though PPI use in AP treatment reduced the rates of pancreatic pseudocyst formation, it did not show significant effects on other outcomes. PPIs should be recommended only as an addition to the standard of care, if there is a relevant comorbidity or a higher risk for GI bleeding or developing pancreatic pseudocyst.

• #39 Vitamin B12 identified as a potential therapeutic agent in the prevention and treatment of acute pancreatitis

  https://medicalxpress.com/news/2024-10-vitamin-b12-potential-therapeutic-agent.html

  Acute pancreatitis (AP), which affects people of all ages, is one of the leading causes of hospital admission due to gastrointestinal diseases. Approximately 20% of patients develop moderate or severe acute pancreatitis, which carries extremely high mortality and disability rates. Even for those who recover, lifelong complications often follow, significantly affecting their quality of life. […] A team led by Dr. Chuanwen Fan combined human genetic epidemiology and animal models to discover and confirm the role of vitamin B12 in the prevention and mitigation of acute pancreatitis. […] The analysis revealed that higher serum vitamin B12 levels were strongly associated with a reduced risk of developing different types of pancreatitis. […] The results revealed that VB12 directly protects acinar cells from necrosis during the early stages of acute pancreatitis and subsequently reduces T lymphocyte infiltration. Notably, artificially increasing serum B12 levels before and after the induction of pancreatitis not only reduced the severity of the condition but also promoted tissue repair after pancreatic injury.

• #40 Vitamin B12 identified as a potential therapeutic agent in the prevention and treatment of acute pancreatitis

  https://medicalxpress.com/news/2024-10-vitamin-b12-potential-therapeutic-agent.html

  „These exciting new findings add to the growing evidence that vitamin B12 can reduce the severity of acute pancreatitis by increasing ATP levels in pancreatic tissue, offering novel insights into potential therapeutic strategies for this disease. This study lays a robust foundation for future clinical applications of vitamin B12 in managing acute pancreatitis,” Prof. Mo concludes.

• #41

  https://link.springer.com/article/10.1007/s44411-025-00023-w

  Acute pancreatitis is one of the serious diseases of the gastrointestinal tract with possible systemic complications. The goal of AP therapy is thorough supportive treatment after obtaining hemodynamic status, prevention of necrosis, infection of the pancreas and organ failure. […] Therefore, the use of antioxidants to improve the antioxidant status of cells has been investigated as a possible approach to the medical treatment of AP. […] The role of oxidative stress (OS) and free radicals in the pathogenesis of AP has been demonstrated. […] Therefore, substances that ameliorate OS and pancreatic pathology are of great interest in research into the treatment of AP. […] Until then, natural antioxidants may be used to prevent pancreatitis in patients who are predisposed to the development of acute or acutely exacerbated chronic pancreatitis. They may also ameliorate milder forms of AP.

• #41 Nutritional advice for prevention of acute pancreatitis: review of cur | NDS

  https://www.dovepress.com/nutritional-advice-for-prevention-of-acute-pancreatitis-review-of-curr-peer-reviewed-fulltext-article-NDS

  Pancreatitis is inflammation of the pancreas that can be acute and self-limiting or, in a small percentage of patients, recurrent. […] Prevention of RAP may decrease those burdens and halt progression to chronic disease. […] Unfortunately, no therapy has proven effective at altering the course of RAP. […] While enteral nutritional therapy plays an important role in the treatment of acute pancreatitis during episodes, nutritional advice provided to patients in an attempt to prevent recurrent episodes has not proven effective in most cases. […] Discontinuing alcohol consumption and treating dyslipidemia with diet and medication can help patients with these issues. […] In patients whose pancreatitis is associated with celiac disease or eosinophilic gastroenteritis, a gluten-free diet and avoidance of food allergens can be effective in stopping RAP.

• #42 Nutritional advice for prevention of acute pancreatitis: review of cur | NDS

  https://www.dovepress.com/nutritional-advice-for-prevention-of-acute-pancreatitis-review-of-curr-peer-reviewed-fulltext-article-NDS

  Advice to take pancreatic enzyme replacement therapy, lose weight, control diabetes, decrease dietary sucrose, decrease dietary fat or avoid monosodium glutamate has little to no evidence of efficacy. […] Some studies suggest that an antioxidant cocktail may decrease the frequency of RAP and the intensity of chronic pain, but the evidence is weak. […] Nutritional therapy may have a role in the treatment of patients with RAP. […] At present, there are no clear guidelines for nutritional advice to give these patients. […] More studies are needed to identify nutritional interventions that will benefit patients with RAP.

• #43 Prevention of Acute Pancreatitis by Broccoli Components

  https://www.ideals.illinois.edu/items/86235

  Acute pancreatitis is a common and refractory inflammatory disease affecting pancreatic acinar cells. […] One promising area of research is preventive intervention by early inhibition of nuclear factor-kappaB (NF-kappaB). […] Therefore, we hypothesized that dietary pretreatment of male F344 rats with crambene will ameliorate acute pancreatitis by inhibiting inflammatory mediators. […] Overall, these data suggest that there is preliminary evidence that consumption of broccoli could be used as a preventive treatment to reduce the severity of acute pancreatitis.

• #44 Prevention Of The Late Complications Of Acute Pancreatitis – Available technology for licensing from the UCLA

  https://techtransfer.universityofcalifornia.edu/NCD/30333.html

  UCLA researchers in the Department of Medicine and Surgery have developed a novel therapeutic for the prevention of late inflammatory complications in severe acute pancreatitis patients. […] In acute pancreatitis patients and also those with burns, trauma, and other acute insults, prevention of LPS release from the gut lumen into the portal vein could therefore decrease inflammation, and lessen the severity of late disease complications. […] Administration of the GLP-2 analog in an acute pancreatitis model decreased pulmonary and hepatic inflammation while decreasing LPS entry into the portal vein. […] This treatment may decrease circulating LPS in severe acute pancreatitis patients and other patients with multi-organ failure following an acute insult, and could therefore reduce morbidity and mortality in critical illness. […] GLP-2 or GLP-2 analog infusion in patients with systemic inflammation may substantially decrease morbidity and mortality from multi-organ failure.

• #45 Acute pancreatis! The silent attack. | Bangkok Hospital Headquarter

  https://www.bangkokhospital.com/en/content/acute-pancreatitis

  To lower risks of developing acute pancreatitis, lifestyle modifications include: […] Stop drinking alcohol. […] Choose a low-fat diet emphasizing on fresh fruits, vegetables and lean protein. […] Regularly exercise. […] Have annual check-ups regularly. […] If warning signs and symptoms are suspected, do not wait. Immediate medical attention must be provided as soon as possible.

• #46 Prevention and treatment of acute pancreatitis: information for patients

  https://dobrobut.com/en/med/c-profilaktika-i-lecenie-ostrogo-pankreatita-informacia-dla-pacientov

  Prevention of the disease is based on the rejection of alcohol and unhealthy food. Follow the diet, monitor your weight, treat inflammatory diseases of the biliary tract in time and undergo an annual preventive examination in the clinic. Avoid fatty, fried foods and fast food. Prevention of pancreatitis is feasible physical activity, good nutrition, timely treatment of gastrointestinal diseases and the implementation of all doctor’s recommendations.

• #47 Pancreatitis – symptoms, causes and treatment | healthdirect

  https://www.healthdirect.gov.au/pancreatitis

  Can pancreatitis be prevented? […] Depending on the cause of your pancreatitis, there may be ways to you can prevent pancreatitis from recurring. […] You may need to reduce your intake of fatty foods and to eat a healthy diet. This is especially important if the cause was gallstones and your gallbladder has not been removed. Drinking plenty of clear fluid, like water, will also help prevent another episode. […] If the cause of your pancreatitis was alcohol, you will need to stop drinking completely to avoid recurrence. […] If you smoke, quitting can also help.

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