Abstract
Acute pancreatitis induce a catabolic stress that increase systemic inflammatory response with worsening nutritional status. Current approach in acute pancreatitis therapy was still symptomatic because of no definitive therapy yet to prevent any inflammatory and proteolytic cascade. One of the most important thing to consider in acute pancreatitis therapy was nutritional management. “Pancreatic rest” concept that formerly used have been known to increase cost, sepsis incidence due to catheter use, and also metabolic and electrolyte disorder. Nowadays, “gut rousing” concept was preferable compared to “pancreatic rest” concept, support that nutritional management was needed to stimulate and generate intestinal function. Enteral nutrition administration have to consider patient’s hemodynamic status. Necrosis incidence, respiratory failure, intensive care, and mortality was found to be lower in patients given enteral nutrition in first 48 hours compared to after 48 hours. Nutrition administration via nasogastric tube or nasojejunal tube was still in doubt while several studies showed that nasogastric tube administration was safe and tolerated, otherwise could be evaluated in larger population sample study. Nutrition and metabolic monitoring was also an important part to reach nutritional goals and reduce complications.
Highlights
$FXWH SDQFUHDWLWLV ZDV DQ LQÀDPPDWRU\ GLVRUGHU that can lead to systemic inflammatory response syndrome (SIRS), multiorgan failure, and death
Most of acute pancreatitis will UHVROYHZLWKRXWWKHUDS\RUWKHQHHGRIVSHFL¿FWKHUDS\ Among 20% of them was progressed into severe acute pancreatitis and need an intensive care with operative management
Until 1990, total parenteral nutrition and resting intestinal function was recommended in acute pancreatitis management due to reduce pancreatic exocrine secretion
Summary
$FXWH SDQFUHDWLWLV ZDV DQ LQÀDPPDWRU\ GLVRUGHU that can lead to systemic inflammatory response syndrome (SIRS), multiorgan failure, and death. If there were no enteral nutrition administration during phase III, it will worsen intestinal dysfunction and cause a progressive acute pancreatitis. Nutritional administration in upper GI tract (above jejenum) will stimulate pancreatic enzyme secretion that worsen patients condition, so that gastric tube insertion was avoided. Eatock et al investigate the use of gastric tube for severe acute pancreatitis patients, followed by two another RCT, concluded that enteral nutrition administration via nasogastric tube (NGT) was wellWROHUDWHG DQG QR VLJQL¿FDQW GLIIHUHQFH LQ PRUWDOLW\ and the need of surgical correction. Two meta analysis with 131 severe acute pancreatitis concluded that there were no difference in motality, length of stay, infection complication, and multi organ failure in patients having nutrition via nasogastric tube and conventional method. There were still need a larger sample size study for the effectivity of NGT nutritional route tolerantion and safety.[12]
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