Nutritional Support

Patients with acute pancreatitis should be considered to be at moderate to high nutritional risk, because of the catabolic nature of the disease and the impact of the patient’s nutritional status for disease development. The principles of nutritional management of patients with acute pancreatitis have evolved over several decades. Traditionally the concept of ‘pancreatic rest’ (which is perhaps the oldest dogma in the management of acute pancreatitis) was used, and it was considered that enteral nutrition (EN), delivered into any part of the upper gastrointestinal tract other than the jejunum, stimulates pancreatic enzyme secretion, leading to increased pancreatic autodigestion and, consequently, exacerbation of the severity of acute pancreatitis. This concept is based on only physiologic assumption and is not supported by good-quality scientific evidence. Further studies have found that pancreatic enzyme secretion is significantly reduced in acute pancreatitis and the secretion was inversely related to the severity of pancreatitis. A lower secretion of trypsin, amylase and lipase was found in severe pancreatitis, and these data suggest that the injured acinar cells cannot fully respond to physiologic stimuli, and may explain why enteral feeding is safe and does not worsen autodigestion during an attack of pancreatitis. This chapter outlines the current principles of nutritional support of patients with acute pancreatitis.