Acute pancreatitis – Authors' reply

We thank Eduardo Argaiz and Alice Gallo de Moraes as well Thomas Finucane Robin McKenzie for their comments on our Seminar about acute pancreatitis.1Boxhoorn L Voermans RP Bouwense SA et al.Acute pancreatitis.Lancet. 2020; 396: 726-734Summary Full Text PDF PubMed Scopus (33) Google Scholar With regards to fluid management, we agree with that the optimal approach management pancreatitis is still unclear. As outlined in Seminar,1Boxhoorn undirected aggressive therapy clearly detrimental patients therefore should be avoided. Fluid resuscitation goal-directed. The high intravenous (5–10 mL/kg per h) mentioned International Association of Pancreatology/American Pancreatic guidelines referenced Seminar1Boxhoorn relates initial hours patient tailored clinical response, including urine output.2Working Group IAP/APA guidelinesIAP/APA evidence-based pancreatitis.Pancreatology. 2013; 13: e1-e15Crossref (828) also that, when stabilisation has been reached, administration substantially reduced guided by frequent reassessment haemodynamic status.3Leppäniemie A Tolonen M Tarasconi al.2019 WSES severe pancreatitis.World J Emerg Surg. 2019; 14: 27Crossref (106) There are many developments field sepsis,4Douglas IS Alapat PM Corl KA al.Fluid response evaluation sepsis hypotension shock: a randomized trial.Chest. 158: 1431-1445Summary (29) meta-analysis pancreatitis,5Gad MM Simons-Linares CR Is beneficial pancreatitis? control trials cohort studies.World Gastroenterol. 26: 1098-1106Crossref (9) which were unfortunately not yet published drafted 2019. similar now used might relevant pancreatitis, focus future studies. Second, regarding findings PYTHON trial,6Bakker OJ van Brunschot S Santvoort HC al.Early versus on-demand nasoenteric tube feeding pancreatitis.N Engl Med. 2014; 371: 1983-1993Crossref (153) raised McKenzie, (control) group received fluids, but allowed eat they requested food. Caloric intake was evaluated during first week after admission: group, dietitians registered type quantity hospital food tolerated calculated amount calories provided patient. After 72 h, all offered an oral this at 96 could started if diet tolerated. acknowledge intolerance indication start feeding, obviously these had insufficient caloric intake. In aimed underline basis early does reduce risk infection or death. RPV research support from Boston Scientific acted consultant Scientific. MGB Ethicon, Medtronic, Intuitive, Mylan. All other authors declare no competing interests. Acute pancreatitisAcute unpredictable potentially lethal disease. prognosis mainly depends development organ failure secondary pancreatic peripancreatic necrosis. past 10 years, treatment moved towards multidisciplinary, tailored, minimally invasive approach. Despite improvements critical care, associated mortality rates. Seminar, outline latest evidence diagnostic therapeutic strategies pancreatitis. Full-Text pancreatitisLotte Boxhoorn colleagues1 correctly point out randomised controlled shows replacement leads increase (mean infusion 408 mL/h vs 264 mL/h).2 Although scarcity proceed mention outdated advising excessive 350–700 70 kg individual). pancreatitisDiscussing Lotte refer trial,2 multicentre trial enteral within 24 h did rate (25% 26%) (11% 7%) compared feeding. Their conclusion can initiated once have h.1