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Nutrition in acute pancreatitis.

S Abou-Assi1, S J O'Keefe

  • 1Division of Gastroenterology, Medical College of Virginia Hospitals and Physicians of the Virginia Commonwealth University Health System, Richmond 23298-0711, USA.

Journal of Clinical Gastroenterology
|March 14, 2001
PubMed
Summary

Enteral nutrition is a safer and more effective treatment for severe acute pancreatitis than total parenteral nutrition. This approach reduces systemic inflammation and complications, offering a better patient outcome.

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Area of Science:

  • Gastroenterology
  • Critical Care Medicine
  • Nutritional Support

Background:

  • Acute pancreatitis can progress to severe systemic inflammatory response and multiple organ failure.
  • Negative nitrogen balance correlates with mortality in severe cases.
  • Nutrition support aims to meet metabolic demands without exacerbating pancreatic autodigestion.

Purpose of the Study:

  • To evaluate the efficacy and safety of enteral nutrition versus total parenteral nutrition in managing severe acute pancreatitis.
  • To determine the optimal nutrition support strategy for patients with acute pancreatitis.

Main Methods:

  • Review of recent controlled clinical trials comparing modified enteral diets (delivered via nasojejunal tube) with total parenteral nutrition.
  • Analysis of patient outcomes, including systemic inflammatory response, complications, and cost-effectiveness.

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Main Results:

  • Enteral nutrition, using elemental or polymeric formulas, was found to be cheaper and safer than total parenteral nutrition.
  • Enteral nutrition was more effective in reducing the systemic inflammatory response compared to total parenteral nutrition.
  • Total parenteral nutrition, while not significantly stimulating pancreatic secretion, carries risks like catheter sepsis and hyperglycemia.

Conclusions:

  • Modified enteral nutrition delivered via nasojejunal tube represents a superior therapeutic approach for severe acute pancreatitis.
  • Enteral nutrition offers improved outcomes and reduced complications compared to traditional total parenteral nutrition.
  • Further research is needed to elucidate the pathophysiologic mechanisms underlying the benefits of enteral nutrition in acute pancreatitis.