Abstract
Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that is characterized by severe abdominal pain, elevated pancreatic enzymes, and pancreatic changes on abdominal imaging. AP is, by nature, an inflammatory process that leads to protein catabolism and an increased metabolic rate, highlighting the strong need for early nutritional support in the initial management of the disease process. The goal of nutritional support in acute pancreatitis is to correct the negative nitrogen balance to reduce inflammation and improve outcomes. Many trials and multiple systemic reviews and meta-analyses have examined the best modality, timing, and composition of nutritional support for acute pancreatitis. Early enteral nutrition has emerged as an important aspect of the clinical management of AP. This narrative review aimed to provide an overview of the clinical management of nutrition in acute pancreatitis based on the currently available data.
Highlights
Acute pancreatitis (AP) is an acute inflammatory process of the pancreas. It presents with severe abdominal pain and the diagnosis is supported by elevated pancreatic enzymes and/or characteristic findings on abdominal imaging
A more recent meta-analysis from Wu et al in 2018 included 11 randomized trials and a total of 562 patients. They found that enteral nutrition significantly decreased the mortality rate and lowered the risk of infections and other complications compared to parenteral nutrition
Even in cases of severe acute pancreatitis, where patients may require further interventions, such as percutaneous or endoscopic drainage, and endoscopic or minimally invasive surgical necrosectomy, enteral nutrition and oral food intake can be safe and feasible and guidelines recommend that enteral nutrition can be initiated in the first 24 h after a procedure if the patient is otherwise clinically stable [6]
Summary
Acute pancreatitis (AP) is an acute inflammatory process of the pancreas. It presents with severe abdominal pain and the diagnosis is supported by elevated pancreatic enzymes and/or characteristic findings on abdominal imaging. Acute pancreatitis occurs along a clinical spectrum and is categorized as mild, moderately severe, or severe based on the extent of pancreatic injury and the presence and duration of systemic organ failure [3]. The inflammatory nature of AP, which includes the release of inflammatory mediators, leads to systemic inflammatory response syndrome (SIRS), catabolic stress, local pancreatic and peripancreatic necrosis, organ failure, and possible death [5]. The highly inflammatory state leads to the catabolic nature of the disease and puts patients at moderate-to-high nutritional risk [6]. Almost 90% of patients are still made “nothing by mouth” or “nil per os (NPO)” at the time of admission based on historical dogma to provide bowel rest, despite more recent evidence supporting the opposite [8]
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