Nutritional Support in Acute Pancreatitis

Acute pancreatitis is an inflammatory disease of the pancreas. Acute abdominal pain is the most common symptom, and increased concentrations of serum amylase and lipase confirm the diagnosis. Pancreatic injury is mild in 80% of patients, who recover without complications. The remaining patients have a severe disease with local and systemic complications. Acute pancreatitis is a hypercatabolic state resulting in rapid loss of body weight, fat and protein. Nutritional support is an integral part of patient care and is started early in the course of disease. Patients with mild to moderate disease (80% of patients) do not require enteral nutrition (EN) or parenteral nutrition (PN), as they will begin oral feeding within 4 days of presentation. Nutritional support is needed for severe disease, EN is preferred over PN, and use PN when EN is contraindicated or not feasible. Most groups have used nasojejunal feeding, which has difficulties in maintenance of the tube position and patency. Nasogastric feeding in severe acute pancreatitis has shown little difference in terms of clinical outcome from nasojejunal feeding. In this review, we review the role, methods, and clinical implications of nutritional supports in acute pancreatitis and also present recently recommended standard guidelines.

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