Vnitr Lek 2026, 72(4):224-230 | DOI: 10.36290/vnl.2026.046
Acute pancreatitis: a practical update through the eyes of young gastroenterologists
- 2. interní gastroenterologická klinika Fakultní nemocnice Hradec Králové a Lékařská fakulta v Hradci Králové, Univerzita Karlova
Background: Acute pancreatitis (AP) is one of the most frequent gastrointestinal diseases with a steadily increasing incidence. Despite declining mortality, clinical practice remains burdened by outdated management strategies not aligned with current evidence.
Aim: To provide a practical and up-to-date overview of the diagnosis, classification and management of acute pancreatitis for internal medicine physicians, highlighting recent paradigm shifts in clinical practice.
Methods: This narrative review is based on current international guidelines (2025) and recommendations of professional societies. It summarizes contemporary evidence on etiology, diagnostic criteria, severity assessment, indications for imaging, and modern therapeutic management including fluid resuscitation, analgesia, nutritional support, antibiotic strategy, biliary management and treatment of local complications.
Results: Routine early CT imaging and prophylactic antibiotics are not recommended. Initial management should focus on goal-directed fluid resuscitation with balanced crystalloids, effective analgesia and early oral or enteral nutrition. ERCP should be performed selectively, mainly in patients with concomitant cholangitis or confirmed choledocholithiasis. In necrotizing pancreatitis, a step-up approach with drainage and minimally invasive endoscopic necrosectomy is preferred over open surgery.
Conclusion: Contemporary management of acute pancreatitis relies on early supportive care, selective use of invasive interventions and a multidisciplinary approach. Adherence to current guidelines reduces morbidity and improves patient outcomes.
Keywords: acute pancreatitis, necrotizing pancreatitis, ERCP, nutrition, infected necrosis, walled-off necrosis.
Accepted: June 11, 2026; Published: June 24, 2026 Show citation
References
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