Cecilie Siggaard Knoph

Background and Objectives: Acute abdominal pain frequently presents to emergency departments, yet outcome domains in randomized controlled trials (RCTs) remain poorly characterized. This review identified pain‐related domains and outcome measures used in RCTs on acute abdominal pain. Databases and Data Treatment: This PRISMA‐guided systematic review was registered in PROSPERO (CRD42025630171). PubMed, Embase, Scopus, and Web of Science were searched for RCTs (January 2000–February 2025). Eligible studies included adult and paediatric patients with acute abdominal pain reporting pain assessment. Outcome domains extracted included pain intensity, rescue analgesia, adverse effects, pain interference, quality of life (QoL), and psychological function. Bias was assessed using Cochrane RoB2. Results: Of 826 records, 43 RCTs were included; eight included children. In adult trials, pain intensity was assessed using the visual analogue scale ( n = 19) or the numeric rating scale ( n = 15). Rescue analgesia (44%) and adverse effects (84%) were frequently reported. No study assessed pain interference or psychological function, and QoL was listed as an outcome in one trial. All were conducted in emergency settings, with short‐term follow‐up within the first hours. Conclusions: Pain assessment in acute abdominal pain RCTs is predominantly limited to intensity measures and short‐term outcomes. While appropriate for immediate analgesic effects, this approach may be insufficient when broader treatment goals or longer follow‐up are relevant. Context‐specific outcome selection is needed, aligning domains with clinical purpose and time frame. Significance: RCTs on acute abdominal pain assess pain incompletely, focusing predominantly on intensity rather than broader domains such as pain interference and psychological function. None adhered to the INTEGRATE framework for pain assessment. This review provides the first systematic mapping of outcome domains in this area, offering a foundation for context‐specific outcome selection aligned with what matters to patients.

Pain is often the presenting symptom of acute pancreatitis (AP) and has a prognostic significance, with poorly treated pain affecting patient outcomes. Despite this, there are currently no international recommendations for pain management in patients admitted with AP. This current guideline was developed following the United European Gastroenterology framework for the development of high‐quality clinical guidelines. Nine working groups were formed to develop statements on pain management in AP from admission to discharge. After systematic literature reviews, the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted using three rounds of Delphi method. The guidelines concluded that acute postoperative pain management guidelines are applicable for treating acute pain due to AP. The numerical rating scale is preferred for pain assessment because of better compliance. Opioids currently form the cornerstone of severe pain management. Potent opioids such as buprenorphine and pentazocine provide superior pain relief over non‐opioid medications and decrease the need for rescue analgesia. Current evidence does not consistently demonstrate harm from opioids in AP. In patients with severe pain, safety concerns should not delay the timely use of opioids to ensure adequate pain management. Specific recommendations concerning the use of epidural analgesia, acupuncture and management of pain in the paediatric population and during pregnancy are provided based on evidence and expert opinions. Finally, the unmet needs for future research were discussed and proposed.

Background and aims: No medications are currently approved for the prevention of recurrent acute pancreatitis. This trial evaluated whether naldemedine, a peripherally acting μ ‐opioid receptor antagonist, reduces the risk of acute pancreatitis in patients with recurrent acute pancreatitis. Methods: This was a multicentre, double‐blinded, placebo‐controlled randomised trial conducted at four Danish pancreatitis referral centres. Participants aged 18–75 years with recurrent acute pancreatitis, both with and without a diagnosis of chronic pancreatitis, were randomised to receive naldemedine 0.2 mg or a matching placebo daily for up to 12 months. The primary outcome was acute pancreatitis recurrence, defined by the revised Atlanta Criteria. Secondary outcomes included pain flares, gastrointestinal symptoms, and quality of life. At the end of follow‐up, the participant's global impression of change, safety and tolerability outcomes, new‐onset diabetes and pancreatic exocrine insufficiency were assessed. Results: 74 participants (mean age: 46 years; 41% female) were randomised to naldemedine ( n = 36) or placebo ( n = 38). During a median follow‐up time of 365 days (IQR, 352–370), participants in the naldemedine group had a numerically lower risk of acute pancreatitis compared to placebo (HR 0.54; 95% CI, 0.29–1.01; p = 0.05). No differences were observed between the groups for secondary efficacy, safety, and tolerability outcomes. Participants treated with naldemedine for at least 1 year had a lower risk of acute pancreatitis (HR 0.49; 95% CI, 0.24–0.97; p = 0.04). Conclusions: Treatment with naldemedine was safe and well‐tolerated and may reduce the risk of recurrent acute pancreatitis. A larger confirmatory trial is needed to verify these findings. Trial registration: ClinicalTrials.gov Identifier: PAMORA‐RAP: NCT04966559

Pain is a dominant symptom in acute pancreatitis, yet high-level evidence guiding optimal analgesic management in acute pancreatitis has been limited. Emerging evidence suggests a role of non-steroidal anti-inflammatory drugs, including cyclooxygenase-2 inhibitors, and opioids in the management of pain in acute pancreatitis patients. Based on a narrative review of the current literature, we provide an overview of available evidence, give an update on recent studies, and propose a treatment algorithm for pain management in acute pancreatitis, considering pharmacological and non-pharmacological modalities, patient comorbidities, and disease severity. Existing studies are generally limited by small sample sizes, heterogeneity in outcomes, unidimensional pain assessments, and a lack of understanding for the pathophysiology of pain in acute pancreatitis. Future trials should focus on multicentre collaboration, comprehensive pain evaluation, adequate sample sizes, and understanding the complex molecular mechanisms of acute pancreatitis pain.

Endoscopic ultrasound (EUS) is a helpful tool for the study of the mediastinum, a challenging region for both transesophageal and endobronchial (EBUS) endosonography. This area is divided into sections and contains numerous lymph nodes essential for the staging and diagnosis of conditions like lung cancer, sarcoidosis, and infections. EUS allows for detailed examination of the mediastinal region, identifying various kinds of abnormalities, whether they are benign cysts or malignant tumors. The aim of this narrative review is to provide a clear overview of how EUS contributes to mediastinal diagnostics and to offer practical insights for clinicians. A comprehensive, non-systematic search of PubMed was conducted by the authors to identify relevant studies. EUS methods, such as elastography and contrast-enhanced imaging, have improved diagnosis by analyzing tissue stiffness and blood flow, and they help endosonographers distinguish between different conditions. EUS-guided tissue sampling techniques, like fine needle aspiration and biopsy, are crucial for detecting cancer and examining lymph nodes in a minimally invasive way. By combining EUS with endobronchial ultrasound, operators can achieve more accurate results, especially in cancer staging and treatment planning. Overall, this approach is a key tool in treating thoracic and mediastinal conditions.

Introduction: Dysmotility is common in acute pancreatitis (AP) and may be evaluated using radiopaque markers and imaging. We present a simple CT‐based approach, which was employed in hospitalized patients with AP.Methods: This was a secondary analysis of a randomized, controlled trial conducted at four Danish centers. Patients admitted with AP and systemic inflammatory response syndrome were randomized to receive 5 days of intravenous methylnaltrexone or placebo (lactated ringer) added to standard management. Self‐reported stool frequency was documented daily. Patients ingested a capsule containing 10 radiopaque markers on Day 3. A subsequent CT scan on Day 5 was used to identify the location of retained markers for the calculation of gastrointestinal transit, and colonic dimensions (diameters and cross‐sectional areas) were measured.Results: In total, 47 patients were included. Patients receiving methylnaltrexone less often had laxative treatment (57% vs. 88%, p = 0.01) compared with placebo. Transit times were similar between the methylnaltrexone and the placebo groups (difference, −4 h (95% CI, −16 to 8), p = 0.53). Marker retention scores, colon diameters, and colon cross‐sectional areas did not differ between treatment groups (all p > 0.05). Transit times (ρ = −0.53; p < 0.001), marker retention scores (ρ = −0.42; p = 0.004), diameter (ρ = −0.43; p = 0.003), and cross‐sectional areas (ρ = −0.36; p = 0.01) of the descending colon were negatively correlated with self‐reported stool frequency.Conclusion: Our CT‐based method was feasible in hospitalized patients with AP. Methylnaltrexone did not change gastrointestinal transit compared with placebo. However, laxative therapy was more frequent with the placebo.

Background: Emerging evidence suggests that individuals who recover from acute pancreatitis may face a significant risk of mortality during the early post‐discharge period. Despite these concerns, comprehensive population‐based studies on this issue are lacking. Objectives: To study in‐hospital and post‐discharge mortality in patients with acute pancreatitis and how it has changed over time. Methods: In a Danish nationwide population‐based cohort study, we included all adults discharged after an incident episode of acute pancreatitis between 2002 and 2017. For each patient, five individuals from the general population, matched by age and sex, were selected as controls. We used Cox regression analysis to assess all‐cause mortality at 90 days, 1, 2, and 5 years post‐discharge and to examine trends in in‐hospital and post‐discharge mortality over the study period. Models were adjusted for comorbidities, heavy smoking, alcohol abuse and sociodemographic factors. Results: Of 28,759 adults with incident acute pancreatitis, 956 (3.3%) died in hospital. The 27,803 patients discharged from the hospital following an incident episode of acute pancreatitis were matched with 139,035 individuals (mean age 58.1 years, 51.1% men). The cumulative post‐discharge mortality at 90 days was 5.0% for the acute pancreatitis cohort and 0.55% for controls. The mortality risk was significantly increased in acute pancreatitis patients at 90 days post‐discharge (adjusted hazard ratio [aHR] 7.62; 95% CI 6.86–8.45); the risk attenuated over time but remained elevated for up to five years (aHR 1.85; 95% CI 1.79–1.92). In‐hospital mortality decreased over the study period (aHR 0.65; 95% CI 0.53–0.81) from 2002–2005 to 2014–2017, while post‐discharge mortality risk remained stable (aHR 0.85; 95% CI 0.72–1.01). Gastrointestinal and cardiovascular diseases accounted for 59.4% of 90‐day post‐discharge deaths. Conclusions: In‐hospital mortality for acute pancreatitis has improved in recent years. However, the risk of post‐discharge mortality remains high, especially in the first 90 days after discharge.