ADVANCES IN THE CLINICAL MANAGEMENT OF ACUTE PANCREATITIS: CURRENT EVIDENCE, DIAGNOSTIC APPROACHES, THERAPEUTIC STRATEGIES, CRITICAL CARE MANAGEMENT, AND EMERGING EVIDENCE-BASED INTERVENTIONS

Nader Saad Awad Al-Mutairi*, Mashan Mashal Hubaylis Alharthi, Shaie Saleh, Hzam Alkorbi Zid Aldossri, Mohammad Naseer Ali Alqahtani, Faisal Zabin Hashar Alotaibi

ABSTRACT

Background: Acute pancreatitis is one of the most common gastrointestinal emergencies and is associated with substantial morbidity, mortality, prolonged hospitalization, and healthcare expenditures worldwide. Although most patients experience a mild and self-limiting course, approximately 20% develop severe disease characterized by pancreatic necrosis, persistent organ failure, and life-threatening systemic complications. Recent advances in evidence-based management have shifted the focus toward early risk stratification, goal-directed supportive care, optimized nutritional strategies, and selective use of invasive interventions. Aim: This review aimed to summarize contemporary evidence regarding the assessment and evidence-based management of acute pancreatitis, with emphasis on severity prediction, fluid resuscitation, pharmacologic and nonpharmacologic therapies, nutritional support, management of underlying etiologies, and prevention of disease recurrence. Methods: A comprehensive narrative review of current international guidelines randomized controlled trials, systematic reviews, meta-analyses, and observational studies was conducted. Evidence addressing prognostic assessment, intravenous fluid therapy, antibiotic use, emerging pharmacologic agents, nutritional management, biliary interventions, and recurrence prevention was critically synthesized. Results: Simple laboratory markers, particularly blood urea nitrogen, hematocrit, and serum creatinine, demonstrated prognostic performance comparable to complex scoring systems. Early goal-directed fluid resuscitation with Lactated Ringer's solution significantly improved clinical outcomes and reduced complications. Routine prophylactic antibiotics and targeted pharmacologic therapies showed no consistent clinical benefit. Conclusion: Contemporary management of acute pancreatitis relies primarily on early supportive care, individualized risk assessment, timely enteral nutrition, and treatment of the underlying cause. Evidence-based implementation of these strategies improves patient outcomes while reducing complications, mortality, and disease recurrence.

Keywords: Acute pancreatitis; fluid resuscitation; enteral nutrition; pancreatic necrosis; antibiotics; severity prediction; Lactated Ringer's solution; recurrence; evidence-based management; supportive care.