Abstract:
BACKGROUND : Acute on chronic pancreatitis (ACP) is a relatively common condition, but there are significant
gaps in our knowledge on the definition, incidence, diagnosis, treatment and prognosis.
METHODS : A systematic review that followed PICO (Population; Intervention; Comparator; Outcome)
recommendation for quantitative questions and PICo (Population, Phenomenon of Interest, Context) for
qualitative research was done to answer 10 of the most relevant questions about ACP. Quality of evidence
was judged by the GRADE criteria (Grades of Recommendation, Assessment, Development and Evaluation).
The manuscript was sent for review to 12 international experts from various disciplines and
continents using a Delphi process.
RESULTS : The quality of evidence, for most statements, was low to very low, which means that the recommendations
in general are only conditional. Despite that, it was possible to reach strong levels of
agreement by the expert panel for all 10 questions. A new consensus definition of ACP was reached.
Although common, the real incidence of ACP is not known, with alcohol as a major risk factor. Although
pain dominates, other non-specific symptoms and signs can be present. Serum levels of pancreatic enzymes
may be less than 3 times the upper limit of normal and cross-sectional imaging is considered
more accurate for the diagnosis in many cases. It appears that it is less severe and with a lower mortality
risk than acute pancreatitis.
CONCLUSIONS : Although the evidence base is poor, this position statement provides a foundation from
which to advance management of ACP.
