Acute pancreatitis, a prevalent illness with devastating consequences, poses a grave threat to those affected. There has been a steady increase in the occurrence of acute pancreatitis at about 3% per year from 1961 to 2016. There are 3 main guidelines on acute pancreatitis, including the American College of Gastroenterology, the International Association of Pancreatology/American Pancreatic Association guideline in 2013, and the American Gastroenterological Association guideline in 2018. However, several milestone studies have been published since then. We hereby reviewed the current acute pancreatitis guidelines with an update on clinical practicechanging literature. The aggressive or moderate fluid resuscitation in acute pancreatitis (WATERFALL) trial recommended fluid resuscitation with lactated Ringer’s solution at a moderate aggressive rate. All guidelines did not recommend prophylactic antibiotics use. Early enteral feeding reduces morbidity. A clear liquid diet is no longer recommended. Nutrition with nasogastric or nasojejunal feeding does not have a difference. The upcoming high vs. low-energy administration in the early phase of acute pancreatitis (GOULASH) trial will provide more information on the impact of calorie intake. Pain management should be individualized based on the degree of pain and severity of pancreatitis. In patients with moderate to severe and severe acute pancreatitis, a step-down approach with epidural analgesia can be considered for moderate to severe pain. The management of acute pancreatitis has evolved. New research on the impact of electrolytes, pharmacologic agents, the role of anticoagulants, and nutrition support will provide scientific and clinical evidence to improve patient care and decrease morbidity and mortality. Cite this article as: Huang Y, Badurdeen DS. Acute pancreatitis review. Turk J Gastroenterol. 2023;34(8):795-801.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has surged as a major cause of liver transplants in the United States. Existing studies have presented conflicting findings regarding the association between liver characteristics (specifically steatosis and fibrosis) and mortality. This study investigates the relationship between the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) via vibration-controlled transient elastography (VCTE) and all-cause mortality in MASLD patients. Methods: Using the NHANES 2017-2018 database, 3821 individuals representing the United States population with MASLD underwent VCTE for liver stiffness measurement. Exclusion criteria were applied, eliminating ineligible cases, incomplete examinations, underage individuals, and those with hepatitis B or C, along with significant alcohol consumption history. Cox proportional hazard models assessed the hazard ratio (HR) for all-cause mortality in CAP and LSM. Cox regression analysis with interaction terms was employed for deeper exploration. Results: The study unveiled a strong, independent correlation between LSM and all-cause mortality. However, the CAP failed to demonstrate a significant association with mortality in both univariate and adjusted analyses, contrary to recent findings. The analysis underscores the importance of accurately measuring liver stiffness via VCTE in predicting adverse outcomes in MASLD patients, emphasizing the pivotal role of fibrosis in assessing mortality risk. Conclusion: This study reaffirms the robust link between liver fibrosis (measured through VCTE) and mortality among MASLD individuals. The absence of a significant association between steatosis (indicated by CAP) and mortality challenges recent research, urging further comprehensive investigations with larger cohorts to delineate steatosis’ precise impact on MASLD-related mortality.

The aim of this study was to investigate the nationwide trend of feeding tube placement during the COVID-19 pandemic and to explore its potential implications for the healthcare system. This was a nationwide retrospective trend analysis of feeding tube placement in adult hospitalizations from 2016 to 2020 using the National Inpatient Sample database. We analyzed the total number of feeding tubes placed endoscopically PEG and percutaneous endoscopic jejunostomy [PEJ]), surgically, and by Interventional Radiology (IR). The average monthly case number of feeding tube placements increased from 20,902 before the pandemic to 22,358 during the pandemic, which corresponds to .8% and 1.0% of hospitalizations, respectively. The odds of undergoing a feeding tube placement during the pandemic were significantly higher than before the pandemic (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.15-1.24; P < .001). Quantitatively, there were 23,904 (95% CI, 17,294-30,515) excess feeding tube placements, or 12,954 (95% CI, 7,116-18,793) excess feeding tube placements in patients surviving hospitalizations during the pandemic. The majority of the increase in feeding tube placements were done endoscopically, as shown by a higher number of excess cases (25,052; 95% CI, 21,543-28,560) compared with the surgical group (4548; 95% CI, 3336-5761) and the IR group (–4106; 95% CI, –9488 to 1276). Our study highlights the significant increase in feeding tube placements during the COVID-19 pandemic. Future research is warranted to accurately estimate the long-term care needs and evaluate the potential impact of increased feeding tube placements during the pandemic on the healthcare system.