Clinical study on nutrition support in patients with severe acute pancreatitis

Abstract

Compared to TPN, the combined therapy of EN and PN could improve the nutrition status and moderate the acute phase response obviously. Moreover, the integrity of enteric mucosa and immune function were protected more effectively in treatment group than in the control one. On the other hand, EN did not simulate the excretion of pancreas and avoid exaggerating the inflammation of pancreas. Thus, appropriate application of PN and EN appears to be more effective for patients with SAP.

What is New in Acute Pancreatitis?

“…Another trial demonstrated an attenuated systemic inflammatory response in enterally fed patients with reduction levels of CRP, IL-6 and TNF-a [28]. The recent meta-analysis has analyzed 6 good quality trials concluding that the enteral nutrition is associated with significant reduction in infective complications, requirement for surgical intervention and shorter length of hospital stay with a trend towards reduction in mortality [29].…”

History and Evolution of the Management of Acute Pancreatitis

“…Nutrition Acute pancreatitis creates a hypermetabolic state, and comprehensive metabolic support is required regardless of the severity of the disease and the co-morbidities of the patient (1,73,74). In patients with mild to moderate pancreatitis, gastrointestinal rest with adequate fluid resuscitation is usually sufficient initial management.…”

“…Recent studies of the physiology of the gastrointestinal tract have demonstrated benefits of enteral feeding especially related to its trophic effects on the intestinal tract (53,74,76,77).…”

“…As reviewed previously, the pathophysiologic events in acute pancreatitis are initiated and perpetuated by failure of the control of the state of activation of the pancreatic enzymes in the acinar cell and ductal lumen. Some studies have demonstrated that gastric or duodenal feeding increases the production of enzymes by the pancreas, which may further stimulate or aggravate the disease process and cause more complications (1,2,30,31,74).…”

“…In patients with mild to moderate pancreatitis, gastrointestinal rest with adequate fluid resuscitation is usually sufficient initial management. The oral route for feeding should be re-established as soon as the nausea subsides, and provided that the pain does not reappear upon feeding (1,2,6,52,53,73,74,75).…”