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World J Gastroenterol. Nov 21, 2014; 20(43): 16123-16131
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16123
Enteral nutrition in acute pancreatitis: A review of the current evidence
Attila Oláh, Laszlo Romics Jr
Attila Oláh, Department of Surgery, Petz Aladár Teaching Hospital, H-9023 Győr, Hungary
Laszlo Romics Jr, Department of Surgery, Glasgow Victoria Infirmary, Glasgow G42 9TY, United Kingdom
Author contributions: Oláh A designed research; Oláh A and Romics Jr L performed literature search, analyzed data and wrote the paper.
Correspondence to: Attila Oláh, MD, PhD, MRCS, Department of Surgery, Petz Aladár Teaching Hospital, P.O. Box 92, H-9023 Győr, Hungary. olaha@petz.gyor.hu
Telephone: +36-96-418244 Fax: +36-96-507907
Received: February 11, 2014
Revised: May 5, 2014
Accepted: July 22, 2014
Published online: November 21, 2014
Abstract

The use of enteral feeding as part of the management of acute pancreatitis dates back almost two decades. This review describes the indications for and limitations of enteral feeding for the treatment of acute pancreatitis using up-to-date evidence-based data. A systematic review was carried out to analyse current data on the use of enteral nutrition in the management of acute pancreatitis. Relevant literature was analysed from the viewpoints of enteral vs parenteral feeding, early vs delayed enteral nutrition, nasogastric vs nasojejunal feeding, and early oral diet and immunonutrition, particularly glutamine and probiotic supplementation. Finally, current applicable guidelines and the effects of these guidelines on clinical practice are discussed. The latest meta-analyses suggest that enteral nutrition significantly reduces the mortality rate of severe acute pancreatitis compared to parenteral feeding. To maintain gut barrier function and prevent early bacterial translocation, enteral feeding should be commenced within the first 24 h of hospital admission. Also, the safety of nasogastric feeding, which eases the administration of enteral nutrients in the clinical setting, is likely equal to nasojejunal feeding. Furthermore, an early low-fat oral diet is potentially beneficial in patients with mild pancreatitis. Despite the initial encouraging results, the current evidence does not support the use of immunoenhanced nutrients or probiotics in patients with acute pancreatitis.

Keywords: Acute pancreatitis, Enteral nutrition, Immunonutrition, Probiotics

Core tip: The application of enteral feeding in acute pancreatitis is much debated. This systematic review provides global insight for clinicians on how to incorporate enteral feeding in the management of acute pancreatitis. The timing, route and composition of enteral nutrition are discussed with up-to-date evidence-based data, and the latest relevant guidelines are also detailed. Importantly, enteral nutrition significantly reduces mortality in severe acute pancreatitis compared to parenteral nutrition. Furthermore, early commencement of enteral feeding (within the first 24 h) is beneficial, and the safety of the nasogastric route seems to be equal to that of the nasojejunal route.