Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.16935
Revised: April 24, 2014
Accepted: May 26, 2014
Published online: December 7, 2014
It is currently difficult for conventional treatments of acute pancreatitis (AP), which primarily consist of anti-inflammatory therapies, to prevent the progression of AP or to improve its outcome. This may be because the occurrence and progression of AP, which involves various inflammatory cells and cytokines, includes a series of complex immune events. Considering the complex immune system alterations during the course of AP, it is necessary to monitor the indicators related to immune cells and inflammatory mediators and to develop more individualized interventions for AP patients using immunomodulatory therapy. This review discusses the recent advances in immunomodulatory therapies. It has been suggested that overactive inflammatory responses should be inhibited and excessive immunosuppression should be avoided in the early stages of AP. The optimal duration of anti-inflammatory therapy may be shorter than previously expected (< 24 h), and appropriate immunostimulatory therapies should be administered during the period from the 3rd d to the 14th d in the course of AP. A combination therapy of anti-inflammatory and immune-stimulating drugs would hopefully constitute an alternative to anti-inflammatory drug monotherapy. Additionally, the detection of the genotypes of critical inflammatory mediators may be useful for screening populations of AP patients at high risk of severe infections to enable the administration of early interventions to improve their prognosis.
Core tip: In light of the complex immune system alterations that occur in acute pancreatitis (AP), it is necessary to develop more individualized interventions for AP patients by using immunomodulatory therapy instead of inflammatory drug monotherapy. We first suggest how we could monitor the immune status of these patients and identify optimal treatment methods. We also demonstrate for the first time that the detection of the genotypes of critical inflammatory mediators may be useful for screening populations of AP patients at high risk of severe infections.