Review
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 7, 2006; 12(21): 3314-3323
Published online Jun 7, 2006. doi: 10.3748/wjg.v12.i21.3314
Consensus of primary care in acute pancreatitis in Japan
Makoto Otsuki, Masahiko Hirota, Shinju Arata, Masaru Koizumi, Shigeyuki Kawa, Terumi Kamisawa, Kazunori Takeda, Toshihiko Mayumi, Motoji Kitagawa, Tetsuhide Ito, Kazuo Inui, Tooru Shimosegawa, Shigeki Tanaka, Keisho Kataoka, Hiromitsu Saisho, Kazuichi Okazaki, Yosikazu Kuroda, Norio Sawabu, Yoshifumi Takeyama, The Research Committee of Intractable Diseases of the Pancreas
Makoto Otsuki, Department of Gastroenterology and Metabolism, University of Occupational and Environmental Health, School of Medicine, Kitakyuushu, Japan
Masahiko Hirota, Department of Surgery II, Kumamoto University Medical School, Japan
Shinju Arata, Critical Care and Emergency Center, Yokohama City University School of Medicine, Japan
Masaru Koizumi, Ohara Medical Center Hospital, Japan
Shigeyuki Kawa, Department of Medicine, Gastroenterology, Shinshu University School of Medicine, Japan
Terumi Kamisawa, Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Japan
Kazunori Takeda, Department of Surgery, National Hospital Organization Sendai Medical Center, Japan
Toshihiko Mayumi, Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Japan
Motoji Kitagawa, Department of Internal Medicine, National Center for Geriatrics and Gerontology, Japan
Tetsuhide Ito, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Japan
Kazuo Inui, Department of Internal Medicine, Fujita Health University, Second Teaching Hospital, Japan
Tooru Shimosegawa, Division of Gastroenterology, Tohoku University School of Medicine, Japan
Shigeki Tanaka, Second Department of Internal Medicine, Showa University School of Medicine, Japan
Keisho Kataoka, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Japan
Hiromitsu Saisho, The Department of Medicine and Clinical Oncology, Graduate School of Medicine Chiba University, Japan
Kazuichi Okazaki, Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Japan
Yosikazu Kuroda, Department of Gastroenterological Surgery, Kobe University Graduate School of Medical Sciences, Japan
Norio Sawabu, Department of Medical Oncology, Kanazawa Medical University, Japan
Yoshifumi Takeyama, Department of Surgery, Kinki University School of Medicine, Osaka, Japan
Supported by the Research Committee of Intractable Diseases of the Pancreas (Chairman; M. Otsuki), provided by the Ministry of Health, Labour, and Welfare, Japan
Correspondence to: Makoto Otsuki, MD, PhD, Department of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of Medicine 1-1, Iseigaoka, Yahatanishi-Ku, Kitakyushu 807-8555, Japan. mac-otsk@med.uoeh-u.ac.jp
Telephone: +81-93-6917251 Fax: +81-93-6920107
Received: January 12, 2006
Revised: January 28, 2006
Accepted: March 13, 2006
Published online: June 7, 2006
Abstract

The incidence of acute pancreatitis in Japan is increasing and ranges from 187 to 347 cases per million populations. Case fatality was 0.2% for mild to moderate, and 9.0% for severe acute pancreatitis in Japan in 2003. Experts in pancreatitis in Japan made this document focusing on the practical aspects in the early management of patients with acute pancreatitis. The correct diagnosis of acute pancreatitis and severity stratification should be made in all patients using the criteria for the diagnosis of acute pancreatitis and the multifactor scoring system proposed by the Research Committee of Intractable Diseases of the Pancreas as early as possible. All patients diagnosed with acute pancreatitis should be managed in the hospital. Monitoring of blood pressure, pulse and respiratory rate, body temperature, hourly urinary volume, and blood oxygen saturation level is essential in the management of such patients. Early vigorous intravenous hydration is of foremost importance to stabilize circulatory dynamics. Adequate pain relief with opiates is also important. In severe acute pancreatitis, prophylactic intravenous administration of antibiotics at an early stage is recommended. Administration of protease inhibitors should be initiated as soon as the diagnosis of acute pancreatitis is confirmed. A combination of enteral feeding with parenteral nutrition from early stage is recommended if there are no clear signs and symptoms of ileus and gastrointestinal bleeding. Patients with severe acute pancreatitis should be transferred to ICU as early as possible to perform special measures such as continuous regional arterial infusion of protease inhibitors and antibiotics, and continuous hemodiafiltration. The Japanese Government covers medical care expense for severe acute pancreatitis as one of the projects of Research on Measures for Intractable Diseases.

Keywords: Fluid resuscitation; Protease inhibitor treatment; Antibiotic treatment; Continuous regional arterial infusion; Contrast-enhanced computed tomography