Reply to the Letter of Drs. Bodnár and Várvölgyi

Dear Sir,

We thank Dr. Bodnár and Dr. Várvölgyi for their comments. We agree with them that early jejunal feeding should be initiated in all attacks of acute pancreatitis predicted to be severe. This route of nutritional support has been demonstrated to be safe, feasible, and less costly than the parenteral one. Its clinical benefits rely mainly on the reduction of line-related infections. The beneficial effects regarding maintenance of gut structural and immune barrier function, incidence of secondary pancreatic infection, and possibly on immunomodulation await further unequivocal confirmation, however, in a controlled study that is adequately powered.

In our patient, complete obstruction of the duodenum by the hematoma precluded jejunal access. We think that the placement of the nasojejunal tube should be carefully considered on an individual basis in those patients with this unusual complication.