Nutrition in acute pancreatitis: when, what and how

Abstract

Purpose of reviewThis review intends to discuss recently available evidence in three topics related to nutrition in patients with acute pancreatitis, namely timing of refeeding, type of nutritional therapy and its route of administration.Recent findingsRecent lines of research confirm that early oral feeding leads to shorter length of stay, fewer complications and lower costs in patients with acute pancreatitis. Moreover, early (<48 h) enteral nutrition led to decreased hospital mortality in patients with mild and severe acute pancreatitis; thus, in case of intolerance to oral feeding or severe disease, nutritional therapy should be offered within 24–72 h. Furthermore, enteral nutrition should be preferred against parenteral nutrition, as it is related to shorter length of stay and less complications, while initial data bring to light the potential role of the soluble dietary fibre polydextrose as an agent that could lead to faster achievement of energy goal with concomitant lower rates of feeding intolerance. Finally, enteral nutrition can be administered through gastric or jejunal feeding, depending on digestive tolerance, whereas latest data also address the safety of percutaneous gastrostomy with a jejunal extension for enteral nutrition administration. However, more data about its real benefit are warranted.SummaryAccumulating evidence confirms the importance of early oral refeeding or early administration of enteral nutrition as vital parts of the armamentarium for the management of patients with acute pancreatitis.

Nutrition in Acute Pancreatitis: From the Old Paradigm to the New Evidence

“…The presence of multiple proinflammatory mediators and resulting systemic inflammatory response syndrome (SIRS) can be attributed to this phenomenon [58]. Nutrition management prevents malnutrition and obviates systemic inflammation, leading to a reduction in pancreatitis complication which helps modify the course of the disease [59,60]. Initially, fasting was considered necessary to guarantee pancreatic rest in order to reduce inflammation through pancreatic stimulation until serum enzyme levels return to normal.…”

Editorial: Nutrition and the gastrointestinal tract

“…They call for more research to assess the effects of fat restriction versus a standard fat diet on both short-and long-term outcomes in pediatric pancreatitis. Of interest, the EFFORT (effect of dietary fat content on the recurrence of pancreatitis) trial will start including patients soon.The role of nutrition in adults' pancreatitis is covered by Arvanitakis et al [2]. They discuss the role of obesity as a risk factor for severe acute pancreatitis and highlight early oral feeding to lead to shorter length of stay, fewer complications, and lower intolerance to oral feeding or severe disease, nutritional therapy should be started within 24-72 h, preferentially by enteral route, which appears superior to parenteral nutrition.…”

“…The role of nutrition in adults' pancreatitis is covered by Arvanitakis et al [2]. They discuss the role of obesity as a risk factor for severe acute pancreatitis and highlight early oral feeding to lead to shorter length of stay, fewer complications, and lower intolerance to oral feeding or severe disease, nutritional therapy should be started within 24-72 h, preferentially by enteral route, which appears superior to parenteral nutrition.…”