Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16101
Revised: May 9, 2014
Accepted: June 12, 2014
Published online: November 21, 2014
Enteral nutrition has been strongly recommended by major scientific societies for the nutritional management of patients with acute pancreatitis. Providing severe acute pancreatitis patients with enteral nutrition within the first 24-48 h of hospital admission can help improve outcomes compared to parenteral nutrition and no feeding. New research is focusing in on when and what to feed to best improve outcomes for acute pancreatitis patients. Early enteral nutrition have the potential to modulate the immune responses. Despite this consistent evidence of early enteral nutrition in patients with acute pancreatitis, clinical practice continues to vary due to individual clinician preference. Achieving the immune modulating effects of enteral nutrition heavily depend on proper placement of the feeding tube and managing any tube feeding associated complications. The current article reviews the immune modulating effects of enteral nutrition and pro- and prebiotics and suggests some practical tools that help improve the patient adherence and tolerance to the tube feeding. Proper selection of the type of the tube, close monitoring of the tube for its placement, patency and securing its proper placement and routine checking the gastric residual volume could all help improve the outcome. Using peptide-based and high medium chain triglycerides feeding formulas help improving feeding tolerance.
Core tip: Due to the decreased food intake and increased nutrient requirements, patients with acute pancreatitis are at increased risk of malnutrition. Beyond meeting calorie and protein requirements, enteral nutrition exerts an immune modulating effect on the intestinal and systemic immune responses. Achieving the beneficial effects of enteral nutrition requires proper selection, placement and management of the feeding tubes and proper selection of the feeding formula. This review highlights new research of the immune effects of enteral nutrition, probiotics and prebiotics and suggests tools to help improve the patient adherence and tolerance to tube feeding.