Nutrition management in acute pancreatitis: Clinical practice consideration

Abstract

Acute pancreatitis (AP) is a common gastrointestinal disease and the leading cause of hospital admission and healthcare burden among gastrointestinal disorders in many countries. Patients can present with varying degrees of inflammation and disease severity, ranging from self-limiting mild AP to devastating and fatal severe AP. Many factors contribute to malnutrition in AP, especially abnormal metabolism and catabolism related to inflammation. The concept of “pancreatic rest” is not evidence-based. There is however, emerging evidence that supports the use of oral or enteral nutrition to improve nutrition status and to reduce local and systemic inflammation, complications, and death. In mild disease, patients are generally able to initiate solid oral diet and do not require specialized nutrition care such as enteral or parenteral nutrition. In contrast, nutrition interventions are imperative in moderately severe and severe AP. The current article aims to review the latest evidence and suggest practical nutrition interventions in patients with AP, including nutrition requirements, routes of nutrition treatment, types of formula, and the role of nutritional supplements, such as glutamine, probiotics, omega-3 fatty acids, and antioxidants.

Keywords: Acute pancreatitis; Nutrition management; Enteral nutrition; Parenteral nutrition; Nutritional supplement; Nutrition assessment

Core tip: Nutrition intervention helps prevent malnutrition and is a key to reduce inflammation, complications, and death in acute pancreatitis. Current evidence supports the benefits of early enteral nutrition in severe pancreatitis. Gastric and jejunal feeding are equally effective, and polymeric formula is safe, compared to peptide-based formula. Parenteral nutrition should be considered in patients who cannot tolerate enteral nutrition. According to recent data, nutritional supplements, including glutamine, probiotics, omega-3 fatty acids, and antioxidants, may contribute to positive outcomes. While intravenous glutamine shows promising benefits in patients receiving total parenteral nutrition, further studies in other nutritional supplements are needed.