Gut 62:1 doi:10.1136/gutjnl-2012-304051
  • Commentaries

Revision of the Atlanta classification of acute pancreatitis: the editorial perspective

  1. Emad M El-Omar2
  2. on behalf of the editorial board of Gut
  1. 1Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, Philipps University of Marburg, Marburg, Germany
  2. 2Division of Applied Medicine, School of Medicine & Dentistry, Institute of Medical Sciences, Aberdeen University, Foresterhill, Aberdeen, UK
  1. Correspondence to Professor Thomas M Gress, Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, Philipps University of Marburg, Baldinger Strasse, Marburg 35043, Germany; gress{at}

In the present issue of Gut, we publish the revision of the Atlanta classification of acute pancreatitis1 together with two commentaries from expert pancreatologists.2 ,3 Revision of any international classification of disease is always fraught with difficulty and controversy. On behalf of the editorial committee of Gut, we wish to present our journal's perspective on this process.

Most pancreatologists recognised the strong need for revision of the original and long outdated Atlanta classification, which dates back to 1992.4 To revise the classification, an international group of experts chose a web-based consensus-building approach that is described and commented on in this issue of Gut. This approach was not based on a systematic review process, as would be required for the development of clinical practice guidelines.5 This prompted the editorial committee of Gut to initiate an extensive and rigorous review process for this manuscript, that started more than 2 years ago. To foster the international acceptance and consensus process, Gut submitted the manuscript to four rounds of review by six expert pancreatologists on each occasion. The first round of reviews was started in 2010, and each subsequent round required major revisions until the manuscript was finally accepted on 29 August 2012. After the fourth round, five of the six reviewers were satisfied, and the majority of the suggestions were implemented in the manuscript. Of course, many aspects remain debatable, particularly in areas where published data is scarce, and thus, now require verification and validation in prospective clinical trials. In this context, the results of a separate international consultation approach, which reached partly differing conclusions, were submitted to Annals of Surgery and accepted for publication,6 while the revised classification published in this issue of Gut was in its final revisions.

While we fully acknowledge the limitations of the Gut manuscript,1 the editorial committee regard it as a significant and long awaited advance in the field, and are satisfied that the work passed through an extensive and diligent review process. For a discussion of the merits and limitations of the revised classification from different perspectives, the editorial board decided to commission two commentaries2 ,3 from expert pancreatologists, including one from a senior member of the group that authored the competing classification.6

Overall, we hope that the revised classification published in this issue of Gut will stimulate scientific discussions on many aspects of classifying acute pancreatitis, and will lead to much needed prospective clinical trials to validate or improve the classification system.


  • Funding None.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.