アブストラクト
Japanese
Title | 急性膵炎の初期治療 - 早期経腸栄養, 予防的抗菌薬投与, 局所動注療法 - |
---|---|
Subtitle | 〔特集〕急性膵炎診療ガイドライン2021 |
Authors | 土谷飛鳥* |
Authors (kana) | |
Organization | *東海大学医学部医学科総合診療学系救命救急医学 |
Journal | 膵臓 |
Volume | 37 |
Number | 5 |
Page | 229-238 |
Year/Month | 2022 / |
Article | 報告 |
Publisher | 日本膵臓学会 |
Abstract | 要旨: 急性膵炎の初期治療法は, この10〜15年間でパラダイムシフトを迎えた. 経腸栄養に関して, 長い絶食期間が推奨されていたが, 近年, 世界のガイドラインは早期経腸栄養開始を推奨するようになった. 早期に腸管を使用することが予後改善に貢献するというエビデンスが蓄積されてきたためである. また, 予防的抗菌薬投与に関して, 重症膵炎においては長年投与が推奨されてきたが, 世界および日本の最新版ガイドラインでも投与は非推奨となった. さらに蛋白分解酵素阻害薬・抗菌薬膵局所動注療法に関しても, ガイドラインでは臨床研究の位置づけであり推奨していない. このように世界・日本においても大きく潮流が変化している. 従って, 急性膵炎の初期治療に臨むすべての職種には, まずは日本のガイドライン推奨を遵守することが求められ, その上で, ガイドラインや関係学会に求められることは, 推奨内容の啓蒙と疫学的横断研究調査を繰り返すことである. |
Practice | 臨床医学:内科系 |
Keywords | 早期経腸栄養, 予防的抗菌薬, 局所動注療法, ガイドライン, Early enteral nutrition, Prophylactic antibiotics, Regional arterial infusion, Guideline |
English
Title | Initial treatment of acute pancreatitis - Early enteral nutrition, prophylactic antimicrobials, and regional arterial infusion - |
---|---|
Subtitle | |
Authors | Asuka TSUCHIYA* |
Authors (kana) | |
Organization | *Department of Emergency and Critical Care Medicine, Tokai University School of Medicine |
Journal | Journal of the Japan Pancreas Society |
Volume | 37 |
Number | 5 |
Page | 229-238 |
Year/Month | 2022 / |
Article | Report |
Publisher | Japan Pancreas Society |
Abstract | The initial treatment of patients with acute pancreatitis has undergone a paradigm shift in the last 10 - 15 years. Regarding enteral nutrition, long periods of fasting were recommended, but in recent years, guidelines in the world and Japan recommend early initiation of enteral nutrition. Evidence has accumulated that early enteral nutrition contributes to an improved prognosis. In addition, prophylactic administration of antibiotics has long been recommended for patients with severe pancreatitis, but the latest editions of guidelines for acute pancreatitis have deprecated the use of such agents. Furthermore, the guidelines do not recommend regional arterial infusion of protease inhibitors and antibiotics in the pancreas. As described above, the trend is changing drastically in Japan and the rest of the world. Therefore, all professionals involved in the initial treatment of acute pancreatitis must comply with the recommendations of the Japanese guidelines. In addition, the guidelines and their sponsoring academic societies must educate the public about the recommendations and repeat cross-sectional epidemiological studies. |
Practice | Clinical internal medicine |
Keywords | Early enteral nutrition, Prophylactic antibiotics, Regional arterial infusion, Guideline |
- 全文ダウンロード: 従量制、基本料金制の方共に770円(税込) です。
参考文献
- 1) Masamune A, Kikuta K, Hamada S, et al. Clinical prac-tice of acute pancreatitis in Japan: An analysis of na-tionwide epidemiological survey in 2016. Pancreatol-ogy 2020; 20: 629-36.
- 2) Ammori BJ. Role of the gut in the course of severe acute pancreatitis. Pancreas 2003; 26: 122-9.
- 3) Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 1998; 42: 431-5.
- 4) Bakker OJ, van Brunschot S, van Santvoort HC, et al. Early versus on-demand nasoenteric tube feeding in acute pancreatitis. N Engl J Med 2014; 371: 1983-93.
- 5) Zhao XL, Zhu SF, Xue GJ, et al. Early oral refeeding based on hunger in moderate and severe acute pan-creatitis: a prospective controlled, randomized clinical trial. Nutrition 2015; 31: 171-5.
残りの26件を表示する
- 6) Takada T, Isaji S, Mayumi T, et al. JPN clinical prac-tice guidelines 2021 with easy-to-understand expla-nations for the management of acute pancreatitis. J Hepatobiliary Pancreat Sci 2022. Online ahead of print.
- 7) 急性膵炎診療ガイドライン2021 改訂出版委員会編. 急性膵炎診療ガイドライン2021 第5版. 東京 : 金原出版, 2021.
- 8) Leppaniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg 2019; 14: 27.
- 9) Vivian E, Cler L, Conwell D, et al. Acute Pancreatitis Task Force on Quality: Development of Quality Indi-cators for Acute Pancreatitis Management. Am J Gas-troenterol 2019; 114: 1322-42.
- 10) Tenner S, Baillie J, DeWitt J, Vege SS; American Col-lege of Gastroenterology. American College of Gastro-enterology guideline: management of acute pancreati-tis. Am J Gastroenterol 2013; 108: 1400-15; 1416.
- 11) Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroen-terology 2018; 154: 1096-101.
- 12) National Institute for Health and Care Excellence. NICE guideline Pancreatitis. 2020. https://www.nice.org.uk/guidance/ng104
- 13) Working Group IAP/APA Acute Pancreatitis Guide-lines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13: e1-15.
- 14) Poma EM, Olascoaga FZ, Petrov MS, et al. SEMICYUC 2012. Recommendations for intensive care management of acute pancreatitis. Med Inten-siva 2013; 37: 163-79.
- 15) Talukdar R, Tsuji Y, Jagtap N, Pradeep R, Rao GV, Reddy DN. Non-compliance to practice guidelines still exist in the early management of acute pancreatitis: Time for reappraisal? Pancreatology 2021; S1424-3903(21)00471-3. Online ahead of print.
- 16) Machicado JD, Wani S, Quingalahua E, et al. Practice patterns and adherence to nutrition guidelines in acute pancreatitis: An international physician survey. Pancreatology 2021; 21: 642-8.
- 17) Hamada S, Masamune A, Shimosegawa T. Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey. World J Gastroenterol 2017; 23: 2826-31.
- 18) Masamune A, Kikuta K, Hamada S, et al. Clinical prac-tice of acute pancreatitis in Japan: An analysis of na-tionwide epidemiological survey in 2016. Pancreatol-ogy 2020; 20: 629-36.
- 19) Bevan MG, Asrani VM, Bharmal S, Wu LM, Windsor JA, Petrov MS. Incidence and predictors of oral feed-ing intolerance in acute pancreatitis: A systematic re-view, meta-analysis, and meta-regression. Clin Nutr 2017; 36: 722-9.
- 20) Isenmann R, Runzi M, Kron M, et al. Prophylactic anti-biotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology 2004; 126: 997-1004.
- 21) Dellinger EP, Tellado JM, Soto NE, et al. Early antibi-otic treatment for severe acute necrotizing pancreati-tis: a randomized, double-blind, placebo-controlled study. Ann Surg 2007; 245: 674-83.
- 22) Yao L, Huang X, Li Y, Shi R, Zhang G. Prophylactic an-tibiotics reduce pancreatic necrosis in acute necrotiz-ing pancreatitis: a meta-analysis of randomized trials. Dig Surg 2010; 27: 442-9.
- 23) Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev 2010; 2010: CD002941.
- 24) Bai Y, Gao J, Zou DW, Li ZS. Antibiotics prophylaxis in acute necrotizing pancreatitis: an update. Am J Gastroenterol 2010; 105: 705-7.
- 25) Ukai T, Shikata S, Inoue M, et al. Early prophylactic antibiotics administration for acute necrotizing pan-creatitis: a meta-analysis of randomized controlled tri-als. J Hepatobiliary Pancreat Sci 2015; 22: 316-21.
- 26) Baltatzis M, Jegatheeswaran S, O'Reilly DA, Siriwar-dena AK. Antibiotic use in acute pancreatitis: Global overview of compliance with international guidelines. Pancreatology 2016; 16: 189-93.
- 27) 土谷飛鳥, 平下禎二郎, 堀部昌靖, 他. 重症急性膵炎に対する予防的抗菌薬使用の現況. 第49回日本救急医学会総会・学術集会より. 日救急医会誌. in press.
- 28) Montravers P, Kantor E, Constantin JM, et al. Epide-miology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study. Crit Care 2019; 23: 393.
- 29) Barrie J, Jamdar S, Smith N, McPherson SJ, Siriwar-dena AK, O'Reilly DA. Mis-use of antibiotics in acute pancreatitis: Insights from the United Kingdom's Na-tional Confidential Enquiry into patient outcome and death (NCEPOD) survey of acute pancreatitis. Pan-creatology 2018; 18: 721-6.
- 30) Horibe M, Sasaki M, Sanui M, et al. Continuous Re-gional Arterial Infusion of Protease Inhibitors Has No Efficacy in the Treatment of Severe Acute Pancreati-tis: A Retrospective Multicenter Cohort Study. Pan-creas 2017; 46: 510-7.
- 31) Hirota M, Shimosegawa T, Kitamura K, et al. Continu-ous regional arterial infusion versus intravenous ad-ministration of the protease inhibitor nafamostat mesi-late for predicted severe acute pancreatitis: a multi-center, randomized, open-label, phase 2 trial. J Gastro-enterol 2020; 55: 342-52.