. Author manuscript; available in PMC: 2019 Jun 27.

Published in final edited form as: Nat Rev Gastroenterol Hepatol. 2019 Mar;16(3):175–184. doi: 10.1038/s41575-018-0087-5

Table 1 |.

prevention levels and targets applied to pancreatitis

	primary prevention	Secondary prevention	Tertiary prevention
First acute pancreatitis episode
Prevention strategies	• Education of general population • Avoidance of high-risk medications and futile ERCP	• Effective algorithms for early identification and effective in-hospital management of AP	• Screening of patients at high risk
Intervention objectives	• Reducing heavy alcohol use, smoking and obesity • Increasing intake of vegetables • Judicious use of drugs known to induce AP • Restricted use of ERCP	• Early detection of AP and removal of known aetiologies (for example, cholecystectomy, control triglycerides, discontinuation of drugs that induced AP, alcohol, smoking) • Judicious use of opiates, nutrition and fluids to prevent progression of AP severity	• Early detection and management of sequelae (for example, PPDM, EPI) via regular follow-ups • Administration of preventative medications (for example, metformin for PPDM)^a
Responsible sector	• Public health specialists • Primary care physicians • Gastroenterologists	• Primary care physicians • Gastroenterologists • Surgeons • Radiologists	• Primary care physicians • Gastroenterologists • Dietitians • Endocrinologists
Recurrent acute pancreatitis
Prevention strategies	• Education of general population and individuals with prior attack of AP	• Effective in-hospital management of AP	• Screening of high-risk patients
Intervention objectives	• Reducing heavy alcohol use, smoking and obesity • Increasing intake of vegetables • Judicious use of drugs known to induce AP • Avoidance of futile ERCP • Administration of preventative medications (for example, statins)^a	• Removal of known aetiologies (for example, cholecystectomy, control triglycerides, discontinuation of drugs that induced AP, alcohol, smoking) • Judicious use of opiates, nutrition and fluids to prevent progression of AP severity	• Early detection and management of sequelae (for example, PPDM, EPI) via regular follow-ups • Administration of preventative medications (for example, metformin for PPDM)^a
Responsible sector	• Public health specialists • Primary care physicians • Gastroenterologists • Surgeons	• Gastroenterologists • Surgeons	• Primary care physicians • Gastroenterologists • Dietitians • Endocrinologists
Chronic pancreatitis
Prevention strategies	• Education of general population and individuals with prior attack of AP	• Effective algorithms of early identification of CP	• Screening of high-risk patients • Professional health consultancy for patients with CP • Chronic pain management
Intervention objectives	• Reducing heavy alcohol use, smoking and obesity • Increasing intake of vegetables • Administration of preventive medications (for example, statins)^a	• Early detection of CP • Removal of known aetiologies (for example, alcohol, smoking) • Treatment of pancreatic strictures and stones • Discontinuation of alcohol and smoking	• Early detection and management of sequelae (for example, PPDM, EPI) via regular follow-ups • Patient behaviour change • Administration of preventative medications (for example, calcium and vitamin D for osteoporosis, metformin for PPDM^a)
Responsible sector	• Public health specialists • Primary care physicians • Gastroenterologists •Surgeons	• Primary care physicians • Gastroenterologists • Surgeons • Radiologists	• Primary care physicians • Gastroenterologists • Endocrinologists • Pain specialists • Dietitians

AP, acute pancreatitis; CP, chronic pancreatitis; EPI, exocrine pancreatic insufficiency; ERCP, endoscopic retrograde cholangiopancreatography; PPDM, post-pancreatitis diabetes mellitus.

lf confirmed in future studies.