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Nutritional support in acute pancreatitis: an update on management issues
1Wake Forest University School of Medicine, Department of Anesthesiology, Winston-Salem, North Carolina 27157-1009, USA. proberts@wfubmc.edu
Seminars in Respiratory and Critical Care Medicine
|August 10, 2005
Summary
Enteral nutrition is now recommended over total parenteral nutrition for acute pancreatitis patients. This approach is well-tolerated, even in severe cases, and helps prevent complications from starvation.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Surgical Nutrition
Background:
- Acute pancreatitis, particularly necrotizing cases, carries a high mortality risk due to inflammatory and infectious complications.
- The pathogenesis of acute pancreatitis is complex, involving both local and systemic inflammatory responses.
- Traditional treatment relied on supportive care and total parenteral nutrition (TPN), but specific therapies remain elusive.
Purpose of the Study:
- To compare the efficacy and safety of enteral nutrition (EN) versus TPN for nutritional support in acute pancreatitis.
- To evaluate current recommendations for nutritional management in acute pancreatitis.
- To explore potential avenues for improving outcomes through nutritional modulation.
Main Methods:
- Review of recent investigations comparing EN and TPN in acute pancreatitis patients.
- Analysis of tolerance and complications associated with jejunal EN in severe acute pancreatitis.
- Assessment of current clinical recommendations for nutritional support.
Main Results:
- Enteral nutrition, specifically delivered into the jejunum, is well-tolerated in patients with severe acute pancreatitis.
- EN is now recommended as the preferred method of nutritional support over TPN for acute pancreatitis.
- Mild cases may tolerate oral nutrition, while severe or prolonged cases require nutritional support to prevent malnutrition.
Conclusions:
- Enteral nutrition should be attempted before initiating total parenteral nutrition in acute pancreatitis.
- Further research is needed to optimize nutrient composition and explore its role in modulating pancreatitis-induced inflammation.
- Nutritional support is crucial for preventing adverse effects of starvation and nutrient deficiencies in severe acute pancreatitis.
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