Pathogenetic Aspects of the Choice of Drug Therapy in the Treatment of Acute Pancreatitis

Difficulties in determining effective treatment tactics for acute pancreatitis are associated with a complex multifactorial pathophysiological mechanism of the disease development. The central part in the pathogenesis of acute pancreatitis is taken by disorders of pancreatic microcirculation. Regardless of the etiology, increasing changes in microcirculation enhance the degree of pancreatic ischemia, thus intensifying the systemic inflammatory response syndrome and resulting in multisystem organ failure. Initial treatment of patients with moderate-to-severe and severe acute pancreatitis combined with transient or persistent organ failure should be carried out in intensive care units. Currently, there are no drugs effective for the treatment of acute pancreatitis in clinical practice. Initial treatment of various forms of acute pancreatitis is essentially supportive and aimed at relieving pain, nausea and vomiting, infusion therapy and early enteral nutrition. Indications for the use of antibacterial therapy in necrotizing acute pancreatitis are cases of infected pancreatic necrosis confirmed by CT or fine-needle aspiration biopsy, or clinical suspicion of infecting necrotic accumulations. To assess the severity and treat patients with severe acute pancreatitis, coordinated work of a multidisciplinary team of specialists is necessary. In the early stage of severe acute pancreatitis, responsibility for coordinating such multidisciplinary work should be borne by specialists of the intensive care units, at a late stage (in 2 weeks), such a role should be played by surgeons, determining the tactics of treating complications of necrotizing forms of acute pancreatitis and the use of various options for invasive interventions.