Acute pancreatitis, a feared diagnosis among the elderly

Authors: M. Berková;  Z. Berka;  E. Topinková
Authors‘ workplace: Geriatrická klinika 1. LF UK a VFN Praha 1;  2. interní klinika LF UP a FN Olomouc 2
Published in: Geriatrie a Gerontologie 2015, 4, č. 1: 19-25
Category: Review Article


Acute pancreatitis is a non-infectious inflammation primarily arising in the exocrine part of pancreas. Its incidence is slightly increasing (in the Central Europe this means approximately 20 cases/100 000 inhabitants per year). Biliary and alcoholic aetiology is the most common cause of acute pancreatitis. From the point of view of pathological anatomy, acute pancreatitis proceeds as interstitial edematous pancreatitis or acute necrotic pancreatitis. The revised Atlanta classification from 2012 defines three forms of acute pancreatitis according its clinical severity: mild, moderately severe and severe. Multiple organ system failure and infection of pancreatic and extrapancreatic necrosis represent the most severe complications. The most reliable examination procedures are abdominal ultrasonography, contrast enhanced computed tomography and magnetic resonance imaging with cholangiopancreatopgraphy, or alternatively endoscopic ultrasonography. Endoscopic retrograde cholangiopancreatography is used for therapeutic purpose in biliary pancreatitis. Despite of significant therapeutic progress provided at intensive care units and at departments of anesthesiology and resuscitation, mortality of severe pancreatitis with circulatory failure, especially in older polymorbid patients is still high (≥ 50 %).

acute pancreatitis – systemic inflammatory response – organ failure – pancreatic necrosis – mortality


1. Fagenholz PJ, Castillo CF, Harris NS, et al. Increasing United States hospital admissions for acute pancreatitis, 1988-2003. Ann Epidemiol 2007; 17(7): 491–7.

2. Tenner S, Baillie J, DeWitt J, et al. Management of Acute Pancreatitis. Am J Gastroenterol 2013; 108: 1400–1415.

3. Zazula R, Wohl P. Akutní pankreatitida. Medicína pro praxi 2005; 4: 147–151.

4. Dítě P, Lukáš M, Lata J. Akutní pankreatitida. In: Češka R, Ťulc T, Tesař V. Vnitřní lékařství. Praha: Triton 2010. 415–418.

5. Špičák J. Léčba akutní pankreatitidy. Lékařské listy 2010; 11(59): 23.

6. Besselink MG, Berwer TJ, Shoenmaeckers EJ, et al. Timing of surgical intervention in necrotizing pancreatitis. Arch Surg 2007; 142: 1194–1201.

7. Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006; 101: 2379–2400.

8. Badalov N, Tenner S, Baillie J. The Prevention, Recognition and Treatment of Post-ERCP Pancreatitis. JOP 2009; 10(2): 88–97.

9. Špičák J. Etiologie akutní pankreatitidy. In: Akutní pankreatitida. Praha: Grada Publishing 2005. 87–101.

10. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by interna-tional consensus. Gut 2013; 62: 102–111.

11. Tenner S. Initial Management of Acute Pancreatitis: Critical issues during the first 72 hours initial management of acute pancreatitis. Am J of Gastroenterol 2004; 99: 2489–2494.

12. Zheng MH, Xia HH, Chen YP. Rectal administration of NSAIDs in the prevention of post-ERCP pancreatitis: a complementary meta-analysis. Gut 2008; 57: 1632–3.

13. Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc 2002; 56(6 Suppl): S273–82.

14. Steinberg W, DeVries JH, Wadden TA, et al. Tu1502 Longitudinal Monitoring of Lipase and Amylase in Adults With Type 2 Diabetes and Obesity: Evidence From Two Phase 3 Randomized Clinical Trials With the Once-Daily GLP-1 Analog Liraglutide. Gastroenterology 2012; 142 (5): Suppl 1, S 850–851.

15. 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(8): 710–717.

16. Dellinger EP, Tellado JM, Soto NE, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double blind, placebo controlled study. Ann Surg 2007; 245: 674–683.

17. Isenmann R, Runzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology 2004; 126: 997–1004

18. De Vries A, Besselink MG, Buskens E, et al. Randomized controlled trials of antibiotic prophylaxis in severe acute pancreatitis: relationship between methodologic quality and outcome. Pancreatology 2007; 7: 531–538.

19. Gupta R, Patel K, Calder PC, et al. A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis II (APACHE ≥6). Pancreatology 2003; 3: 406–413.

20. Yi F, Ge L, Zhao J, et al. Meta-analysis: total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis. Intern Med 2012; 51: 523–530.

21. Besselink MG, van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet 2008; 371: 651–659.

22. ASGE Standards of Practice Committee. Complications of ERCP. Gastrointestinal Endoscopy 2012; 75(3): 467–473.

23. Freeman ML. Pancreatic stents for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Clin Gastroenterol Hepatol 2007; 5: 1354–1365.

24. Ito K, Fujita N, Noda Y, et al. Can pancreatic duct stenting prevent postERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective biliary cannulation? A prospective randomized controlled trial. J Gastroenterol 2010; 45: 1183–1191.

25. Elmunzer BJ, Waljee AK, Elta GH, et al. A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut 2008; 57: 1262–1267.

26. Zheng MH, Xia HH, Chen YP. Rectal administration of NSAIDs in the prevention of post-ERCP pancreatitis: a complementary meta-analysis. Gut 2008; 57: 1632–1623.

27. Dai HF, Wang XW, Zhao K. Role of nonsteroidal anti-inflammatory drugs in the prevention of post-ERCP pancreatitis: a meta-analysis. Hepatobiliary Pancreat Dis Int 2009; 8: 11-16.

28. Cheon YK, Cho KB, Watkins JL, et al. Efficacy of diclofenac in the prevention of post-ERCP pancreatitis in predominantly high-risk patients: a randomized double-blind prospective trial. Gastrointest Endosc 2007; 66: 1126–1132.

29. Zheng M, Bai J, Yuan B, et al. Meta-analysis of prophylactic corticosteroid use in post-ERCP pancreatitis. BMC Gastroenterol 2008; 8: 6.

30. Bai Y, Gao J, Shi X, et al. Prophylactic corticosteroids do not prevent post-ERCP pancreatitis: a meta-analysis of randomized controlled trials. Pancreatology 2008; 8: 504–509.

31. Dumonceau JM, Andriulli A, Deviere J, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy 2010; 42: 503–515.

32. Concepción-Martín M, Gómez-Oliva C, Juanes A, et al. Somatostatin for prevention of post-ERCP pancreatitis: a randomized, double-blind trial. Endoscopy 2014; 46(10): 851–856.

33. Chen C-C. Somatostatin for Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Never-ending Story? J Chin Med Assoc 2009; 72(2): 57–59.

34. Manolakopoulos S, Avgerinos A, Vlachogiannakos J et al. Octreotide versus hydrocortisone versus placebo in the prevention of post-ERCP pancreatitis: a multicenter randomized controlled trial. Gastrointest Endosc 2002; 55(4): 470–475.

35. Špičák J. Prevence pankreatitidy po ERCP. Gastroent Hepatol 2013; 67(2): 162–164.

Geriatrics General practitioner for adults Orthopaedic prosthetics
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account