[Nutritional problems in acute pancreatitis]

In severe acute pancreatitis the protein catabolism may increase by 80% and energy expenditure by 20%, indicating that nutritional requirements are elevated and interventional nutrition support is mandatory. Because oral feeding may stimulate the synthesis of proteolytic enzymes and perpetuating autolysis, the cornerstone of nutritional support has been the total parenteral nutrition (TPN). Unfortunately the use of TPN has been associated with major metabolic and infectious complications and nutritional alternatives has been looked for. Physiologic studies have shown that infusion of nutrients into the distal jejunum bypassed the stimulatory effect of feeding on pancreatic secretion and many studies compared TPN with jejunal feeding. Jejunal feeding is associated with fewer infections and metabolic complications, and, moreover, is less expensive than TPN. These observations have resulted in the general acceptance of jejunal nutrition as the best nutritional support in severe acute pancreatitis.