AIM: Based on the pathogenesis of severe acute pancreatitis and our experimental studies, to investigate the effect of dexamethasone and dextran in treatment of patients with severe acute pancreatitis.METHODS: Thirty-two patients with severe acute pancreatitis were treated with 0.5-1 rg/kg per day dexamethasone for 3-5 d, and 500-1 000 mL/d of dextran 40 for 7 d, besides the routine therapy.RESULTS: After 4-8 h of treatment, abdominal pain began to be relieved; range of tendess began to be localized in 27 patients. They were cured with nonsurgical treatment.Five of them were deteriorated, and treated with surgery.Four patients in this group died.CONCLUSION: Dexamethasone and dextran 40 block the pathologic process of severe acute pancreatitis through inhibition of inflammatory mediators and improvement of microcirculation disorders respectively.