ABSTRACT
About 20% of acute pancreatitis cases develop necrosis and have a high risk of inflammatory
and infectious complications and a high mortality rate. Acute pancreatitis has a variety
of causes and despite years of research its pathogenesis remains complex and obscure.
Both local and systemic inflammatory responses play key roles in the pathophysiology
of this disorder. Treatment plans continue to rely on supportive care without proven
specific therapies. Pancreatic rest and use of total parenteral nutrition (TPN) were
the gold standard for nutritional support of these challenging patients. Because numerous
studies in other critically ill patients demonstrated benefits of enteral nutrition,
recent investigations compared TPN to enteral nutrition in acute pancreatitis. These
studies indicated that enteral nutrition delivered into the jejunum was tolerated
well, even in patients with severe acute pancreatitis. ``Mild'' cases of pancreatitis
should improve and tolerate oral nutrition within a few days. In contrast, ``severe''
cases of pancreatitis or those with a protracted clinical course require nutritional
support to aid in preventing adverse effects of starvation and nutrient deficiencies.
Current recommendations are to attempt enteral nutrition in patients with acute pancreatitis
prior to instituting TPN. Further studies to determine optimal nutrient composition
are warranted and should investigate the possibility of modulating the inflammatory
response induced by pancreatitis to improve outcomes.
KEYWORD
Acute pancreatitis - enteral nutrition - parenteral nutrition - nutritional support