Controversies in medicine: the treatment of acute pancreatitis.

Oral food and fluid restriction and parenteral fluid substitution are unanimously accepted in the therapy of acute pancreatitis. Most other measures are controversial. The pros and contras of the modern therapeutical recommendations are discussed: gastric tube, antacids, atropine, cimetidine, glucagon, calcitonin, somatostatin, antienzymtherapy with aprotinin, and phospholipase A inhibition, therapeutic peritoneal lavage, improvement of microcirculation with dextrans and heparin, prophylaxis and therapy of complications, parenteral hyperalimentation, early surgical intervention with drainage or resection and endoscopic papillotorny for removal of bile duct stones in biliary acute pancreatitis.