Nutrition and Acute Pancreatitis

Contents

1 Introduction

2 The Pathophysiology

3 The Problem with TPN and Bowel Rest

4 Why Enteral Feeding Is Superior to TPN and Bowel Rest

5 Is Proximal Enteral Feeding Dangerous?

6 Enteral Feeding without Pancreatic Stimulation: Distal Jejunal Feeding

7 Should Enteral Feeding

Be Compared to No Feeding?

8 Can Feeding Influence Outcome?

Summary

Acute pancreatitis is a disease of variable severity and outcome: mild disease may be treated at home, while severe disease often leads to several weeks in the ICU with mortality rates approaching 50%. Cell and molecular biological studies have increased our knowledge of the pathophysiology of the disease dramatically over the past decade, but have not, as yet, led to a specific treatment. All of the improvement in outcome can be attributed to supportive measures, such as nutrition. Clinical investigations have shown that acute pancreatitis is a highly catabolic illness, and protein deficiency could occur before the 2nd week of illness if no feeding is given. Parenteral nutrition (PN) is effective in preventing protein catabolism, and also

From: Clinical Gastroenterology: Nutrition and Gastrointestinal Disease Edited by: M.H. DeLegge © Humana Press Inc., Totowa, NJ

'rests' the pancreas, but increases the already high risk of septic and metabolic side-effects, and worsens outcome in mild illness. Enteral feeding is superior to PN in the management of acute pancreatitis, even if it is polymeric or infused directly into the stomach. Unfortunately, however, enteral feeding stimulates pancreatic trypsin production and may exacerbate the disease process unless delivered well down the jejunum. The most likely reason for the superiority of enteral over parenteral feeding is its capacity to maintain intestinal function and suppress the cytokine-mediated systemic inflammatory response and consequent multiple organ failure.

Key Words: Acute pancreatitis, Enteral feeding

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