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Etiología de la pancreatitis aguda.

Autor: Santhi Swaroop Vege, MD
Editor de sección: David C Whitcomb, MD, PhD
Subdirector: Shilpa Grover, MD, MPH, AGAF

INTRODUCCIÓN

La pancreatitis aguda es una afección inflamatoria del páncreas caracterizada por dolor abdominal y niveles
elevados de enzimas pancreáticas en la sangre. La pancreatitis aguda es una de las principales causas
gastrointestinales de hospitalización en los Estados Unidos [ 1 ]. Varias condiciones están asociadas con
pancreatitis aguda. De estos cálculos biliares y el abuso crónico de alcohol representan aproximadamente dos
tercios de los casos.

Este tema revisará la etiología de la pancreatitis aguda y un enfoque para establecer la etiología subyacente.
Nuestro enfoque es en gran medida consistente con las pautas emitidas por la Asociación Estadounidense de
Gastroenterología y el Colegio Americano de Gastroenterología y se detalla a continuación. La patogenia, las
manifestaciones clínicas, el diagnóstico y el tratamiento de la pancreatitis aguda se analizan por separado. (Ver
"Predicción de la gravedad de la pancreatitis aguda" y "Manejo de la pancreatitis aguda" y "Desbridamiento
pancreático" y "Patogenia de la pancreatitis aguda" ).

EPIDEMIOLOGÍA

La incidencia anual reportada de pancreatitis aguda en los Estados Unidos varía de 4.9 a 35 por 100,000
habitantes [ 2 ]. La incidencia de pancreatitis aguda está aumentando en todo el mundo debido a las mayores
tasas de obesidad y cálculos biliares [ 3 ]. Fumar puede aumentar el riesgo de pancreatitis no relacionada con
cálculos biliares por mecanismos que no están claros y pueden potenciar el daño inducido por el alcohol en el
páncreas [ 4-9 ].

La mortalidad en la pancreatitis aguda generalmente se debe al síndrome de respuesta inflamatoria sistémica y

a la insuficiencia orgánica en el primer período de dos semanas, mientras que después de dos semanas
generalmente se debe a la sepsis y sus complicaciones [ 10,11 ]. En una revisión sistemática de estudios de
pancreatitis aguda, la mortalidad general fue de aproximadamente 5 por ciento, con tasas de mortalidad en
pacientes con pancreatitis intersticial y necrotizante, de 3 por ciento y 17 por ciento, respectivamente [ 12 ]. Sin
embargo, las tasas de mortalidad en la pancreatitis necrotizante pueden ser más bajas en los centros
especializados (rango 6 a 9 por ciento) [ 10,13 ].
ETIOLOGÍA

Gallstones — Gallstones (including microlithiasis) are the most common cause of acute pancreatitis accounting
for 40 to 70 percent of cases [14]. However, only 3 to 7 percent of patients with gallstones develop pancreatitis
[15,16]. The mechanism by which the passage of gallstones induces pancreatitis is unknown. Two factors have
been suggested as the possible initiating event in gallstone pancreatitis: reflux of bile into the pancreatic duct
due to transient obstruction of the ampulla during passage of gallstones; or obstruction at the ampulla
secondary to stone(s) or edema resulting from the passage of a stone [17,18]. Cholecystectomy and clearing the
common bile duct of stones prevents recurrence, confirming the cause-and-effect relationship [15].

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Literature review current through: May 2020. | This topic last updated: Jan 09, 2019.

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