Improvements to pancreatitis guidelines could lead to better long-term outcomes

Researchers from the University of Birmingham have reviewed the current clinical practice guidelines (CPGs) for pancreatitis, noting the differences in guidelines from around the world and highlighting the lack of emphasis on both prevention and rehabilitation.

Acute pancreatitis is a gastrointestinal condition involving inflammation of the pancreas, which affects up to 3 million people a year globally and healthcare costs rising to as high as £200 million annually.

CPGs (which are evidence-based recommendations for care) have been found to vary widely for acute pancreatitis and focus more on treatment and cost-effectiveness than a holistic approach to recovery, calling for a more thorough look into current guidelines and recommendations for improvement.

In a paper published in eClinical Medicine, a team from the University of Birmingham, a systematic review of 22 global CPGs was conducted, which found critical gaps in the strength and quality of these recommendations.

Of the 22 guidelines reviewed, 17 (77%) came from high-income countries, limiting applicability in low- and middle-income countries which may not have similar resources and treatment options. Additionally, recovery, rehabilitation and prevention were poorly addressed, despite current global priorities from the World Health Organisation focusing on rehabilitation. Nearly half of ‘strong’ recommendations for care were based on low- or moderate-quality evidence, suggesting an inconsistency in the level of recommendations and their underlying evidence.

With the risk of recurrence of acute pancreatitis, as well as the long-term complications possible for patients, the lack of standardised guidelines and research has direct consequences for the quality of care for patients, serving as a call to action for research to improve long-term outcomes for patients globally.

Sivesh Kamarajah, lead author on the paper, explains, “Our review shows that today’s acute pancreatitis guidelines are still overwhelmingly focussed on hospital-related management. We analysed 718 individual recommendations and found that only nineteen, under three per cent, address recovery or longer‑term follow‑up, and none deal with palliative care. Notably, recovery or rehabilitation has been identified as important to patients from a recent James Lind Alliance Priority Setting Partnership, despite poor coverage in these guidelines. ”

He continues, “what we need now is an internationally harmonised, truly patient-centred guideline that spans prevention through rehabilitation, is co-created with colleagues in low- and middle-income settings, and is underpinned by robust clinical trials so every patient receives consistent, evidence-based care wherever they are treated.”

To combat the current disparities, the team highlight recommendations such as exploring effective recovery strategies for patients, as well as prioritising developing more comprehensive guidelines that cover a wider range of patient care, whilst also making sure it is standardised, evidence-based and equitable across a diverse range of healthcare settings. The team has now been funded to undertake a programme of work to improve recovery after acute pancreatitis.