Pharmacologic therapy for acute pancreatitis

World J Gastroenterol. 2014 Dec 7;20(45):16868-80. doi: 10.3748/wjg.v20.i45.16868.

Abstract

While conservative management such as fluid, bowel rest, and antibiotics is the mainstay of current acute pancreatitis management, there is a lot of promise in pharmacologic therapies that target various aspects of the pathogenesis of pancreatitis. Extensive review of preclinical studies, which include assessment of therapies such as anti-secretory agents, protease inhibitors, anti-inflammatory agents, and anti-oxidants are discussed. Many of these studies have shown therapeutic benefit and improved survival in experimental models. Based on available preclinical studies, we discuss potential novel targeted pharmacologic approaches that may offer promise in the treatment of acute pancreatitis. To date a variety of clinical studies have assessed the translational potential of animal model effective experimental therapies and have shown either failure or mixed results in human studies. Despite these discouraging clinical studies, there is a great clinical need and there exist several preclinical effective therapies that await investigation in patients. Better understanding of acute pancreatitis pathophysiology and lessons learned from past clinical studies are likely to offer a great foundation upon which to expand future therapies in acute pancreatitis.

Keywords: Acute pancreatitis; Anti-inflammatory; Anti-oxidants; Antisecretory; Mortality; Organ failure; Protease inhibitors; Systemic inflammatory response syndrome.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Disease
  • Animals
  • Anti-Inflammatory Agents / therapeutic use*
  • Antioxidants / therapeutic use*
  • Humans
  • Immunologic Factors / therapeutic use*
  • Pancreas / drug effects*
  • Pancreas / metabolism
  • Pancreas / physiopathology
  • Pancreatitis / diagnosis
  • Pancreatitis / drug therapy*
  • Pancreatitis / metabolism
  • Pancreatitis / physiopathology
  • Protease Inhibitors / therapeutic use*
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Antioxidants
  • Immunologic Factors
  • Protease Inhibitors