[The role of nutrition support in acute pancreatitis]

Nutritional support has been recognised as an important part in the treatment of acute pancreatitis. Acute pancreatitis varies in its severity from mild inflammatory process within pancreatic tissue to severe necrotic pancreatitis with involvement of regional tissues and remote organs leading to the multi organ dysfunction syndrome. Acute pancreatitis results in hypermetabolic, highly catabolic state and negative nitrogen balance, the degree of which is directly related to the severity of the disease and high mortality (up to 40%). The aim of nutritional support is to establish positive nitrogen balance without stimulating pancreatic secretion ofproteolytic enzymes and auto-digestion. Traditionally, fasting ("putting the pancreas at rest") with or without total parenteral nutrition was considered as standard of care. Current knowledge regarding the importance of integrity of intestinal mucosal barrier suggests that early enteral feeding should be implemented. Despite several randomised controlled trials comparing total parenteral with enteral nutrition, some guidelines and recommendations, there are still unsolved questions regarding the type and amount of fluids and calories that should be provided as well the use of the immune-enhancing diets.