Primary prevention

Management of known risk factors should reduce the risk of acute pancreatitis. Eating a balanced, low-fat diet, maintaining adequate triglyceride control, and reducing alcohol intake may help decrease the incidence of pancreatitis.

The use of peri-ERCP rectal indomethacin has been established as a standard of care in decreasing the risk of severe acute post-ERCP pancreatitis.[33][34][35]​​[44]​ There is also evidence to show that intravenous hydration with 1-3 L of Ringer lactate (Hartmann solution) either before, during, or after the procedure can lead to a significant decrease in the incidence of post-ERCP pancreatitis.[35]​​[44][45][46]​​ The use of pancreatic duct stents is recommended for selected high risk patients to reduce the risk of severe pancreatitis following ERCP.​​​​[33][35]​​[44]

For patients with Sphincter of Oddi dysfunction (SOD), ERCP with a sphincterotomy may relieve the mechanical obstruction responsible for pain and pancreatitis; conversely it may precipitate acute pancreatitis, and its use in individuals with idiopathic pancreatitis (and/or chronic pain) should be limited to those with a high likelihood of SOD (e.g., abnormal imaging and abnormal liver function tests).[39]​​

Secondary prevention

The most important aspect of prevention is patient education. Management of risk factors (balanced, low-fat diet, adequate triglyceride control, and decreasing the amount of alcohol intake, preferably to zero) may help to decrease the incidence of recurrent acute pancreatitis. Data now highlight the substantial correlation between cigarette smoking and recurrent acute pancreatitis. Therefore, patients should be strongly encouraged to abstain completely from tobacco use.

The American Gastroenterological Association recommends a brief alcohol counseling intervention during admission.[85]​ Patients with alcohol-induced pancreatitis may need pharmacologic treatment for alcohol withdrawal. Choice of drug and the dose regimen depends on various factors, including the indication (e.g., alcohol-withdrawal seizures, delirium tremens) and patient-specific factors (e.g., presence of hepatic impairment, ability to take oral medication). For detailed recommendations see Alcohol withdrawal. Thiamine, folic acid, and multivitamins are generally used in this group of patients. Magnesium should be replaced, if necessary; low levels are commonly seen in alcoholic patients.[129]

Effectively addressing gallstone disease by any means available (such as cholecystectomy, endoscopic retrograde cholangiopancreatography [ERCP], ursodeoxycholic acid) may decrease ductal obstruction risk and hence the risk of pancreatitis. In patients with hypertriglyceridemia, statin use has been associated with a decreased risk of developing pancreatitis.[130] Other risk factors may be controlled through patient education and medication dose adjustments.[131][132]

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