Nutritional support in acute pancreatitis.

This paper reviews the current practice of nutritional support in acute pancreatitis. Appropriate interventions depend on the severity and duration of the pancreatitis and its complications. Current trends are away from restriction of oral or enteral intake, instead preferring this route to parenteral administration if possible. The role of the gut mucosal barrier in the pathogensis of the systemic response in pancreatitis has led to attempts to use enteral nutritional support to prevent complications, in addition to meeting nutritional needs in patients with long-term severe illness. Many clinicians believe that the management of acute pancreatitis should start from the concept of "pancreatic rest." Based on a simple understanding of pancreatic physiology and a belief that further stimulation of the pancreas during an attack of pancreatitis would exacerbate the inflammatory process by releasing more enzymes, traditional teaching has been that it is necessary to avoid all oral intake to prevent any inappropriate stimulation of pancreatic enzyme production. Accordingly, patients with acute pancreatitis are often deprived of enteral nutrition, and may be given intravenous parenteral nutritional support. Such an approach to nutritional support needs to be revised, since evidence emerging from many recent studies consistently indicates that an enteral route of nutrition is far superior.