Pharmacological approach to acute pancreatitis.
The aim of the present review is to summarize the current knowledge regarding pharmacological prevention and treatment of acute pancreatitis (AP) based on experimental animal models and clinical trials. Somatostatin (SS) and octreotide inhibit the exocrine production of pancreatic enzymes and may be useful as prophylaxis against post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The protease inhibitor gabexate mesilate (GM) is used routinely as treatment to AP in some countries, but randomized clinical trials and a meta-analysis do not support this practice. Nitroglycerin (NGL) is a nitrogen oxide (NO) donor, which relaxes the sphincter of Oddi. Studies show conflicting results when applied prior to ERCP and a large multicenter randomized study is warranted. Steroids administered as prophylaxis against PEP has been validated without effect in several randomized trials. The non-steroidal anti-inflammatory drugs (NSAID) indomethacin and diclofenac have in randomized studies showed potential as prophylaxis against PEP. Interleukin 10 (IL-10) is a cytokine with anti-inflammatory properties but two trials testing IL-10 as prophylaxis to PEP have returned conflicting results. Antibodies against tumor necrosis factor-alpha (TNF-alpha) have a potential as rescue therapy but no clinical trials are currently being conducted. The antibiotics beta-lactams and quinolones reduce mortality when necrosis is present in pancreas and may also reduce incidence of infected necrosis. Evidence based pharmacological treatment of AP is limited and studies on the effect of potent anti-inflammatory drugs are warranted.
Bang
Ulrich-Christian
UC
Department of Gastroenterology, Hvidovre Hospital, Kettegaard Alle 30, Hvidovre DK-2650, Denmark. ulrich_bang@dadlnet.dk
Semb
Synne
S
Nojgaard
Camilla
C
Bendtsen
Flemming
F
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D016670:Gabexate / Q000627:therapeutic use; D006801:Humans; D016753:Interleukin-10 / Q000627:therapeutic use; D005996:Nitroglycerin / Q000627:therapeutic use; D015282:Octreotide / Q000627:therapeutic use; D010195:Pancreatitis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control; D010972:Platelet Activating Factor / Q000037:antagonists & inhibitors; D019936:Probiotics / Q000627:therapeutic use; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000975:Antioxidants; D010972:Platelet Activating Factor; D015842:Serine Proteinase Inhibitors; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D016670:Gabexate; D005996:Nitroglycerin; D015282:Octreotide