title: Acute pancreatitis.
abstract: OBJECTIVE
  To review the changing insights in the pathophysiology and management of acute pancreatitis.
  
  
  RESULTS
  The outdated 1992 Atlanta classification has been replaced by two new classifications, both of which acknowledge the role of organ dysfunction in determining the outcome of acute pancreatitis, and both of which have introduced a new category of 'moderate' pancreatitis. The new classifications will allow fewer patients to be classified as severe, which better reflects the risk of dying of the disease. Intra-abdominal hypertension has emerged as a relevant issue, and strategies to lower intra-abdominal pressure may often be required. Antibiotic prophylaxis has been discontinued for some time, but aggressive fluid resuscitation is also being questioned, and the role of surgery is further reduced as percutaneous drainage of collections has shown to reduce the need for more surgical interventions. If needed, surgery should be as conservative as possible, with minimally invasive strategies preferable. Newer techniques such as endoscopic transgastric drainage are being developed, but their exact role has yet to be defined.
  
  
  CONCLUSIONS
  Management of severe acute pancreatitis is changing fundamentally. 'Less is more' is the new paradigm in acute pancreatitis - less antibiotics, less fluids, less surgery, which should eventually lead to less morbidity and mortality.
authors.affiliation: Ghent University Hospital, Department of Critical Care Medicine, Ghent, Belgium.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: De Waele
mesh_terms: D000208:Acute Disease; D019072:Antibiotic Prophylaxis; D004322:Drainage / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009102:Multiple Organ Failure / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D010195:Pancreatitis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome