ESPEN guideline on clinical nutrition in acute and chronic pancreatitis

Abstract

Both acute and chronic pancreatitis are frequent diseases of the pancreas, which, despite being of benign nature, are related to a significant risk of malnutrition and may require nutritional support. Acute necrotizing pancreatitis is encountered in 20% of patients with acute pancreatitis, is associated with increased morbidity and mortality, and may require artificial nutrition by enteral or parenteral route, as well as additional endoscopic, radiological or surgical interventions. Chronic pancreatitis represents a chronic inflammation of the pancreatic gland with development of fibrosis. Abdominal pain leading to decreased oral intake, as well as exocrine and endocrine failure are frequent complications of the disease. All of the above represent risk factors related to malnutrition. Therefore, patients with chronic pancreatitis should be considered at risk, screened and supplemented accordingly. Moreover, osteoporosis and increased facture risk should be acknowledged in patients with chronic pancreatitis, and preventive measures should be considered.

Impact of interventions targeting the inappropriate use of proton‐pump inhibitors by clinical pharmacists in a hepatobiliary surgery department

“…Based on the EMR review, the indication for PPI use for each patient was categorized as treatment or prevention 25‐28 …”

Nutritional management of chronic pancreatitis: A systematic review and meta‐analysis of randomized controlled trials

“…In agreement with our findings, most international guidelines do not recommend the use of AOs for attenuation of pain. While some guidelines explicitly recommend against them, 51,52 other guidelines do not either include any recommendation at all 53–57 or provide such recommendation but point towards the low level of evidence 58–60 . Rightly, the guideline for CP by the German Society for Digestive and Metabolic Diseases 51 further argues that smoking is common among CP patients and that certain AO combinations, that is the combination of β‐carotene with retinol or α‐tocopherol, could even increase the risk of lung cancer in smokers 61,62 .…”

“…Both oral and intramuscular administrations are suited to treat vitamin D deficiency in CP patients, whereas weekly UVB tanning bed sessions are ineffective. Almost unanimously, international guidelines acknowledge the general risk of micronutrient deficiency in CP and recommend specific supplementation if indicated, however not routinely 51–54,56–60 . For vitamin D supplementation, the guidelines by the German Society for Digestive and Metabolic Diseases 51 and the Spanish Pancreatic Club 59 provide specific recommendations.…”

“…On the basis of these findings and the limited available evidence in this area, recommendations regarding the use of ONS are rare. Thus, ONS is reserved for those patients, in whom a combination of pancreatic enzyme replacement therapy and dietary modification failed to improve nutritional status 51,52,57,59 . Nevertheless, the generalizability of this single study is limited, especially when treating CP patients in Western countries.…”

“…As there are no RCTs that only tested for MCT supplementation, most international guidelines base their recommendations on the findings from this single study. Consequently, supplementation of MCTs is not recommended in general 52,58 or should only be considered when adequate fat absorption cannot be achieved by pancreatic enzyme replacement therapy 51,57,59,60 . These recommendations are further supported by the inferiority of MCTs over long‐chain triglycerides shown in older, non‐randomized studies 63,64 and also by the poor taste and high costs of MCT supplements 57,59 .…”