Does nutrition therapy alter the pathophysiology of severe acute pancreatitis?

Purpose of review: The primary aim of this review is to summarize the value of nutrition therapy in reversing or altering the core pathophysiology during severe acute pancreatitis (SAP) and how it may impact short-term and long-term clinical outcomes.

Recent findings: Early, intense inflammation is ubiquitous during the acute phase of SAP, and specific nutrients like vitamins C, D, and omega-3 fatty acids may modulate inflammation. Omega-3 fatty acids supplementation shows promise in small studies, especially when given parenterally, though results from large randomized trials are pending. Moreover, SAP commonly causes gastrointestinal dysfunction, evidenced by impaired barrier function and motility. Early enteral nutrition (EN) can reduce mucosal inflammation and protect barrier function, with glutamine supplementation potentially offering additional benefits. For impaired motility, which often presents as intra-abdominal hypertension, the commencement of early EN could aid bowel movement, though careful monitoring for ischemia is needed. Long-term outcomes in SAP patients remain understudied, and the impact of nutritional therapy on postdischarge physical function and quality of life warrants further research.

Summary: Nutrition therapy may intervene in the pathophysiology of SAP in many aspects, thereby improving both short-term and long-term outcomes. However, there is a substantial lack of high-quality evidence concerning this topic.