Treatment of acute pancreatitis

Steinberg, William M.; Schlesselman, S

doi:10.1016/0016-5085(87)90275-7

Cited by 102 publications

(13 citation statements)

References 42 publications

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“…Since such events occur early in the clinical course of the disease, we can logically claim that another condition for proper therapy is very early administration of protease inhibitors in relation to onset of symptoms. Experimental data in animals [1]strongly support this claim. Another problem is patient stratification.…”

Section: Introductionsupporting

confidence: 72%

“…Keeping in mind the intrinsic difficulty in planning and interpretation of the human clinical trials on acute pancreatitis, we make an attempt here to review the state of the art in this particular field [1]. The first antiprotease drug to be tested was aprotinin.…”

Section: Introductionmentioning

confidence: 99%

“…Only the severe forms tend to present complications and high morbidity, while the mild forms heal spontaneously. All patients admitted to clinical trials should be suffering from a well-documented severe necrotic from, the presence of patients with mild AP being a misleading factor; the greater statistical power of trials with large numbers of mild AP sufferers is only apparent [1]. …”

Section: Introductionmentioning

confidence: 99%

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Assessment and Treatment of Severe Pancreatitis

Bassi

Falconi

Caldiron³

et al. 1999

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From the theoretical point of view, antiproteolytic therapy would seem to be the rationale for acute pancreatitis management. Unfortunately, clinical human trials studying the role of antiproteases in the treatment of acute pancreatitis differ in several respects in terms of their basic design. As a consequence, any form of homogeneous analysis of the reported data as a whole is impossible. Considering the data emerging from a meta-analysis of five trials a rational use of antiproteases may result in a reduction of complications requiring surgery and of patient management costs only in selected cases, meaning by that severe and necrotic forms. As regards presumptive applications, over 400 patients were prospectively tested versus placebo in a double-blind trial with the aim of preventing acute pancreatitis after ERCP. The complication incidence was significantly lower among the pretreated patients; anyway, also in this field of protease inhibitor clinical application it is necessary to identify the patients with the greatest risk to develop post-ERCP acute pancreatitis. In conclusion, antiproteases can still play a role when given prophylactically or when used in the very early phases of the disease; moreover a ‘multiple drugs approach’ (including, for example, suitable antibiotics) seems to represent nowadays the most modern and rational treatment of acute pancreatitis.

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Section: Introductionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment and Treatment of Severe Pancreatitis

Bassi

Falconi

Caldiron³

et al. 1999

Digestion

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“…Most of these works, however, were conducted with caerulein-induced pancreatitis. Steinberg and Schlesselman [9]have discussed the difficulty of evaluating the effects of CCK-receptor antagonists on CCK- and/or caerulein-induced pancreatitis. Tani et al [10]examined the effects of CCK antagonists in different models of acute pancreatitis, i.e in caerulein-induced pancreatitis and the more severe sodium taurocholate-induced pancreatitis.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Effects of Loxiglumide on Experimental Acute Pancreatitis Using Various Models

Satake

Kimura

Saito³

1999

Digestion

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We investigated the therapeutic effects of a cholecystokinin A (CCK-A) receptor antagonist, loxiglumide, on various models of experimental pancreatitis. This study shows that loxiglumide ameliorated caerulein-induced acute pancreatitis in mice as previously reported. The effects of loxiglumide on hemorrhagic and necrotizing acute pancreatitis is controversial. This study, however, shows that loxiglumide improves the survival rates in necrotizing acute pancreatitis induced by intraductal injection of taurocholate, followed by caerulein injection. In addition, the administration of loxiglumide improved both the biochemical and pathological changes of edematous acute pancreatitis induced by a closed duodenal loop in rats. It is concluded that the CCK-A receptor antagonist, loxiglumide, has therapeutic and/or prophylactic effects on acute pancreatitis in various models of experimental acute pancreatitis.

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“…Patients within this group may require endoscopic retrograde pancreoduodenostomy or endoscopic sphincterotomy if gall stones are present. 6 Such management could only be justified, and its value assessed, in patients with a high risk of developing severe pancreatitis, since the procedures are time consuming, expensive and not without risk.…”

mentioning

confidence: 99%