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J P NEOPTOLEMOS Department of Surgery,University of Liverpool,Royal Liverpool University Hospital,5th Floor UCD Block,Daulby Street, Liverpool L69 3GA, UK
Correspondence to: Professor Neoptolemos. A greater understanding of the natural history of acute
pancreatitis combined with greatly improved radiological imaging has led to improvement in the hospital mortality from acute pancreatitis, from around 25-30% to 6-10% in the past 30 years. Moreover, it is
now recognised that the first phase of severe acute phase pancreatitis is a systemic inflammatory response syndrome (SIRS), during which multiple organ failure and death often supervene. Survival into the
second phase may be accompanied by local complications, such as
infected pancreatic necrosis, which may be prevented by prophylactic antibiotics and treated by judicious surgery. Intensive care unit costs
can be substantial, but might be justified because of the excellent
quality of life of survivors. Reduction in multiple organ failure by
agents such as lexipafant, an antagonist of platelet activating factor
(PAF) (which plays a critical role in generating the SIRS), may
contribute to intensive care unit cost containment, as well as reducing
the incidence of local complications and deaths from acute
pancreatitis. A further improvement in the human and financial costs
also requires the centralisation of the management of patients with
severe acute pancreatitis, to single hospital units whose concentrated
expertise equips them to intervene most effectively in what is still
recognised as a highly complex disease.
(GUT 1998;42:886-891)
© 1998 by Gut
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