Nutritional support in acute pancreatitis

Acute pancreatitis is a catabolic condition requiring adequate nutritional support to avoid severe nitrogen loss. Providing nutrition to the patients with acute pancreatitis is, however, limited by the fact that oral feeding may stimulate the pancreas and aggravate the pancreatitis. Hence, total parenteral nutrition (TPN) is recommended for such patients but that too has limitations apart from its prohibitive cost. At the same time, therefore, enteral feeds have been developed, which provide adequate nutrition and are fairly well tolerated by these patients. Based on the available studies, a rational scheme of managing acute pancreatitis has been recommended. Patients with moderately severe acute pancreatitis who are malnourished or are likely to develop complications requiring surgery should be supported with total parenteral nutrition from an early stage. All patients with severe acute pancreatitis should, on the other hand, be supported with total parenteral nutrition from the beginning, but enteral nutrition via a jejunostomy should be commenced as early as possible since such patients often run a protracted course and giving them TPN might become exorbitantly expensive and impractical. Mixed or polymeric feeds are tolerated well from the sixth or seventh postoperative day but in an occasional patient elemental diet via the jejunostomy may become necessary.