Acute pancreatitis: A two-year update on epidemiology, clinical diagnosis, treatment, and outcomes

Acute pancreatitis (AP) is an acute inflammatory disease with a continually increasing burden and a highly heterogeneous clinical course. The disease is self-limiting in most patients, but some may progress to persistent organ failure and infected pancreatic necrosis and be left with long-term pancreatic functional impairment. Treatment of AP remains based on supportive care, and evidence from the past two years has primarily redefined the patient populations for established interventions, treatment intensity, and timing of implementation. Risk stratification and the level of monitoring should be based on serial assessment of organ function and the patient’s response to initial treatment, rather than on a single score. Early treatment emphasizes goal-directed, moderate-intensity fluid resuscitation in patients with hypovolemia, timely analgesia, and resumption of oral feeding once tolerated; enteral nutrition should be used when intake is inadequate, with stepwise advancement to the target energy intake. A specific sequential regimen of selective cyclooxygenase-2 inhibitors has shown potential to improve AP outcomes, but adequately validated early pharmacologic interventions capable of slowing disease progression remain lacking. For infected pancreatic necrosis, delayed intervention remains the preferred strategy when the condition is controllable; in patients who require intervention, the minimally invasive step-up pathway and timing of debridement should be selected according to clinical status, necrotic burden, and local anatomy. Meanwhile, increasing attention is being paid to etiology-specific recurrence prevention and stratified follow-up for post-AP diabetes, pancreatic exocrine insufficiency, persistent symptoms, and functional recovery, driving a shift in AP management from a single hospitalization to care across the disease course, spanning the acute phase, recovery, and long-term follow-up. From an evidence-based perspective, this narrative review summarizes new evidence from the past two years on the epidemiology, clinical diagnosis and risk stratification, acute-phase treatment, management of local complications, recurrence prevention, and long-term outcomes of AP.