Insights into Acute Pancreatitis: Pathogenesis, Diagnosis, and Management

This narrative review integrates landmark studies, recent publications, and major clinical guidelines to highlight the current state of the art concerning acute pancreatitis, a well-known yet still challenging condition. We will focus on recent practice transitions and future perspectives arising from advances in diagnostic imaging and interventional endoscopy. Pathogenesis and etiology: We carry out an overview of the fundamental mechanisms underlying acute pancreatitis, followed by an analysis of both common and uncommon causes, along with emerging evidence regarding idiopathic forms. Diagnosis and risk stratification: We pursue two objectives: on one hand, to emphasize the enduring importance of clinical assessment in the diagnosis of acute pancreatitis; on the other, to analyze the increasingly central role that imaging has acquired over recent decades. Identification of patients at higher risk for complications or an unfavorable prognosis is crucial. Several scoring systems have been proposed over the past decades, but with limited impact on daily clinical practice. Treatment: Therapeutic approaches have undergone significant revisions over time. Our objective is to provide an overview of the current standards together with best evidence-based medical approaches, targeted and interventional therapies, with focus on the endoscopic ones. Furthermore, we want to clarify the importance of nutrition and its proper management. Conclusions: Acute pancreatitis continues to stimulate discoveries and improvements in clinical management. We will place emphasis on unmet needs and emerging innovations that may importantly influence future practice also promoting evidenced-based standards of care.