Nutrition and Acute Pancreatitis

Abstract

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that is characterized by severe abdominal pain, elevated pancreatic enzymes, and pancreatic changes on abdominal imaging. AP is, by nature, an inflammatory process that leads to protein catabolism and an increased metabolic rate, highlighting the strong need for early nutritional support in the initial management of the disease process. The goal of nutritional support in acute pancreatitis is to correct the negative nitrogen balance to reduce inflammation and improve outcomes. Many trials and multiple systemic reviews and meta-analyses have examined the best modality, timing, and composition of nutritional support for acute pancreatitis. Early enteral nutrition has emerged as an important aspect of the clinical management of AP. This narrative review aimed to provide an overview of the clinical management of nutrition in acute pancreatitis based on the currently available data.

Nutrition in acute pancreatitis: when, what and how

“…Acute pancreatitis is an inflammatory process of the pancreas and it is considered one of the most common gastrointestinal diseases leading to hospitalization [1][2][3]. The diagnosis of acute pancreatitis is based on abdominal pain, elevation of pancreatic enzymes and/or characteristics finding on abdominal imaging [3,4].…”

“…Acute pancreatitis is an inflammatory process of the pancreas and it is considered one of the most common gastrointestinal diseases leading to hospitalization [1][2][3]. The diagnosis of acute pancreatitis is based on abdominal pain, elevation of pancreatic enzymes and/or characteristics finding on abdominal imaging [3,4]. The two main causes of acute pancreatitis are alcohol consumption (25-35%) and gallstones (40-70%), while medications, endoscopic retrograde cholangiopancreatography, hypercalcemia, hypertriglyceridemia, infectious and autoimmune diseases consist of less common causes of acute pancreatitis [4,5].…”

“…Earlier longstanding beliefs that administration of enteral nutrition may lead to increased pancreatic autodigestion and thus to worsening of pancreatitis made bowel rest as the preferred initial treatment during the last decades [3,4]. Since then, many studies showed that timely administrated enteral nutrition could lead to correction of the negative nitrogen balance due to protein catabolism and prevention of malnutrition, highlighting the key role that enteral nutrition could play in the management and treatment algorithm of patients suffering from acute pancreatitis [2,3,5,6,7 ▪▪ ]. Moreover, enteral nutrition can reduce local and systemic inflammation, complications and death by maintaining the integrity of the intestinal barrier reducing its permeability and thus preventing microbiota translocation [7 ▪▪ ] Therefore, it is currently recommended to initiate oral feeding with low fat or soft oral diet, in addition to fluid resuscitation and analgesics, as soon as it is clinically tolerated [2].…”

“…Earlier longstanding beliefs that administration of enteral nutrition may lead to increased pancreatic autodigestion and thus to worsening of pancreatitis made bowel rest as the preferred initial treatment during the last decades [3,4]. Since then, many studies showed that timely administrated enteral nutrition could lead to correction of the negative nitrogen balance due to protein catabolism and prevention of malnutrition, highlighting the key role that enteral nutrition could play in the management and treatment algorithm of patients suffering from acute pancreatitis [2,3,5,6,7 ▪▪ ].…”

Nutritional Support in Patients with Severe Acute Pancreatitis-Current Standards

“…Moreover, just at the SAP beginning, damage to enterocytes due to microcirculatory injury and gut hypoperfusion leads to increased gastrointestinal permeability and translocation of systemic cytokines, toxins, and bacteria [ 18 , 20 ]. Therefore, the goal of the nutritional support (NS) in AP is not only to prevent and treat malnutrition, but also modulate and decrease altered inflammatory response [ 21 ]. Nutrition constitutes the third step of AP management according to the “PANCREAS” (perfusion, analgesia, nutrition, clinical and radiological assessment, endoscopy, antibiotics, surgery) acronym described by Khaliq et al [ 22 ].…”