Neostigmine Treatment of Acute Pancreatitis Combined With Intra-abdominal Hypertension
Neostigmine Treatment of Acute Pancreatitis Combined With Intra-abdominal Hypertension
Acute pancreatitis(A) often complicated with Intra-abdominal Hypertension. After the onset of
 acute pancreatitis, capillary leakage causing ascites,upper gastrointestinal tract
 obstruction and paralytic ileus leading to an elevated IAP, severe IAH leads to ACS with high
 mortality. Neostigmine is an anti-cholinesterase drugs, can enhance intestinal peristalsis,
 promote flatus defecation. The aim of this study was to determine the effect of neostigmine
 on reducing abdominal pressure and clinical prognosis in patients with AP by promoting
 intestinal peristalsis and defecation.
Acute pancreatitis(AP) runs a severe course in around 20% of patients and is associated with
 a mortality up to 30%. Intra-abdominal hypertension(IAH）is a common complication of severe
 acute pancreatitis(SAP). The inflammation of the pancreas starts a cascade of pancreatic and
 visceral edema, acute peripancreatic fluid collections, capillary leakage causing ascites,
 paralytic ileus, and gastric dilatation by upper gastrointestinal tract obstruction leading
 to an elevated intra-abdominal pressure (IAP). A sustained or repeated pathological elevation
 in IAP ≥12 mmHg is defined as IAH, it generally occurs often within the first week after
 onset of SAP. Persistent and serious IAH (IAP >20 mmHg ) often leads to new onset organ
 failure or acute worsening of existing organ failure, which is defined as ACS and associated
 with a mortality rate of 49%.

 In the past practice, many patients with ACS undergo decompressive laparotomy, which
 obviously has a risk of complications. Therefore, numerous medical, nonmedical, and minimally
 invasive therapies have been introduced. Neostigmine is an anti-cholinesterase drugs, can
 enhance intestinal peristalsis, promote flatus defecation. World Society for Abdominal
 Compartment Syndrome (WSACS)guidelines,suggest that neostigmine be used for the treatment of
 established colonic ileus not responding to other simple measures and associated with
 IAH.However, no data exist on the effects of pharmacologic promotility therapy on IAP or
 outcomes among those with IAH/ACS. The aim of this study was to evaluate the efficacy of
 neostigmine on reducing IAP in AP patients with IAH.
Inclusion Criteria:

 1. Age 18-70 year ;

 2. The diagnosis of acute pancreatitis according to the revised Atlanta classification.

 3. IAH is defined as IAP ≥ 12 mmHg by the World Society of Abdominal;Compartment Syndrome
 (WSACS);

 4. After 24 hours of conventional treatment(such as gastrointestinal decompression or
 percutaneous drainage of ascites), the IAP of AP patients with IAH was still ≥ 12
 mmHg;

 5. The onset time of acute pancreatitis was within 2 weeks;

 6. Signed the informed consent.

 Exclusion Criteria:

 1. Previous history of laparotomy;

 2. Mechanical ileus or abdominal hemorrhage were considered clinically;

 3. Those who have contraindications to neostigmine: 1) Patients with angina; 2)
 myocardial infarction; 3) ventricular tachycardia; 4) bradycardia; 5) acute
 circulatory failure; 6) epilepsy; 7) bronchial asthma; 8) mechanical intestinal
 obstruction; 9) urinary tract infarction; 10) hyperthyroidism; 11) serious arrhythmia;
 12) bladder operation; 13) intestinal fistula;

 4. Allergic to neostigmine;

 5. Pregnant or lactating patients.