TY - JOUR
T1 - Position statement on the definition, incidence, diagnosis and outcome of acute on chronic pancreatitis
AU - Bouça-Machado, Tiago
AU - Bouwense, Stefan A. W.
AU - Brand, Martin
AU - Demir, Ihsan Ekin
AU - Frøkjær, Jens Brøndum
AU - Garg, Pramod
AU - Hegyi, Péter
AU - Löhr, J.-Matthias
AU - de-Madaria, Enrique
AU - Olesen, Søren Schou
AU - Pandanaboyana, Sanjay
AU - Pedersen, Jan Bech
AU - Rebours, Vinciane
AU - Sheel, Andrea
AU - Singh, Vikesh
AU - Smith, Martin
AU - Windsor, John A.
AU - Yadav, Dhiraj
AU - Drewes, Asbjørn Mohr
N1 - Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.
PY - 2023/3
Y1 - 2023/3
N2 - BACKGROUND: Acute on chronic pancreatitis (ACP) is a relatively common condition, but there are significant gaps in our knowledge on the definition, incidence, diagnosis, treatment and prognosis.METHODS: A systematic review that followed PICO (Population; Intervention; Comparator; Outcome) recommendation for quantitative questions and PICo (Population, Phenomenon of Interest, Context) for qualitative research was done to answer 10 of the most relevant questions about ACP. Quality of evidence was judged by the GRADE criteria (Grades of Recommendation, Assessment, Development and Evaluation). The manuscript was sent for review to 12 international experts from various disciplines and continents using a Delphi process.RESULTS: The quality of evidence, for most statements, was low to very low, which means that the recommendations in general are only conditional. Despite that, it was possible to reach strong levels of agreement by the expert panel for all 10 questions. A new consensus definition of ACP was reached. Although common, the real incidence of ACP is not known, with alcohol as a major risk factor. Although pain dominates, other non-specific symptoms and signs can be present. Serum levels of pancreatic enzymes may be less than 3 times the upper limit of normal and cross-sectional imaging is considered more accurate for the diagnosis in many cases. It appears that it is less severe and with a lower mortality risk than acute pancreatitis.CONCLUSIONS: Although the evidence base is poor, this position statement provides a foundation from which to advance management of ACP.
AB - BACKGROUND: Acute on chronic pancreatitis (ACP) is a relatively common condition, but there are significant gaps in our knowledge on the definition, incidence, diagnosis, treatment and prognosis.METHODS: A systematic review that followed PICO (Population; Intervention; Comparator; Outcome) recommendation for quantitative questions and PICo (Population, Phenomenon of Interest, Context) for qualitative research was done to answer 10 of the most relevant questions about ACP. Quality of evidence was judged by the GRADE criteria (Grades of Recommendation, Assessment, Development and Evaluation). The manuscript was sent for review to 12 international experts from various disciplines and continents using a Delphi process.RESULTS: The quality of evidence, for most statements, was low to very low, which means that the recommendations in general are only conditional. Despite that, it was possible to reach strong levels of agreement by the expert panel for all 10 questions. A new consensus definition of ACP was reached. Although common, the real incidence of ACP is not known, with alcohol as a major risk factor. Although pain dominates, other non-specific symptoms and signs can be present. Serum levels of pancreatic enzymes may be less than 3 times the upper limit of normal and cross-sectional imaging is considered more accurate for the diagnosis in many cases. It appears that it is less severe and with a lower mortality risk than acute pancreatitis.CONCLUSIONS: Although the evidence base is poor, this position statement provides a foundation from which to advance management of ACP.
KW - Acute pancreatitis
KW - Chronic pancreatitis
KW - Consensus
KW - Inflammation
KW - Pancreas
UR - http://www.scopus.com/inward/record.url?scp=85147360642&partnerID=8YFLogxK
U2 - 10.1016/j.pan.2023.01.010
DO - 10.1016/j.pan.2023.01.010
M3 - Review article
C2 - 36746714
SN - 1424-3903
VL - 23
SP - 143
EP - 150
JO - Pancreatology
JF - Pancreatology
IS - 2
ER -