Severe acute pancreatitis in the elderly is characterized by significant morbidity and mortality rates, with a higher financial impact when compared to the same disease in younger patients [1]. There are some obvious differences between these two populations. The most glaring one is the presence of multiple comorbidities in elderly patients. A previous study showed that comorbidities, such as cardiovascular and renal comorbidities, significantly influence the outcomes of older patients with acute pancreatitis [1]. However, this relationship between age-related comorbidities and outcome is not a consensus. In a recent paper, morbidity and mortality in elderly patients with acute pancreatitis were not affected by multiple comorbidities and higher Charlson score present in older individuals [2]. However, it observed a higher incidence of intra-abdominal infected collections in elderly population, suggesting that the worse outcome of older individuals may be due to increased intestinal bacterial translocation.