prognosis

Last reviewed 06/2021

Mortality from acute pancreatitis ranges from 1% in mild attacks to 50% in severe attacks to almost 100% in patients with multiple complications and poor prognostic signs (1).

Mild acute pancreatitis is generally treated with supportive care including pain control, intravenous fluids, and correction of electrolyte and metabolic abnormalities. A meta-analysis of eight trials revealed that enteral nutrition significantly reduced mortality, multiple organ failure, systemic infections, and the need for surgery compared with parenteral nutrition (2).

To prevent recurrence, the cause should be identified and eradicated. Cholecystectomy should be performed during the same admission if gallstones are suspected, as this is safer than delaying for 3 months. Alcohol should be screened by taking a careful history from the patient and relatives or close friends. Neither plasma gamma glutamyl transpeptidase nor blood alcohol are reliable indicators of abuse. Sadly, advice to abstain may not be heeded.

Most investigators do not believe that chronic pancreatitis results for acute pancreatitis unless complications such as pseudocysts or ductal strictures are present.

Reference:

• Steer ML et al. Chronic pancreatitis. NEJM 1995;332: 1482-9.
• Al-Omran M, Albalawi ZH, Tashkandi MF, Al-Ansary LA: Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database Syst Rev 2010, 20 , CD002837.