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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2020; 8(9): 1561-1573
Published online May 6, 2020. doi: 10.12998/wjcc.v8.i9.1561
Nutrition management in acute pancreatitis: Clinical practice consideration
Narisorn Lakananurak, Leah Gramlich
Narisorn Lakananurak, Leah Gramlich, Department of Medicine, University of Alberta, Edmonton T6G 2R3, Alberta, Canada
Narisorn Lakananurak, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Narisorn Lakananurak, MD, MSc, Doctor, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 254 Phayathai Road, Pathumwan, Bangkok 10330, Thailand. narisorn.l@chula.ac.th
Received: December 20, 2019
Peer-review started: December 20, 2019
First decision: January 12, 2020
Revised: March 7, 2020
Accepted: April 21, 2020
Article in press: April 21, 2020
Published online: May 6, 2020
Abstract

Acute pancreatitis (AP) is a common gastrointestinal disease and the leading cause of hospital admission and healthcare burden among gastrointestinal disorders in many countries. Patients can present with varying degrees of inflammation and disease severity, ranging from self-limiting mild AP to devastating and fatal severe AP. Many factors contribute to malnutrition in AP, especially abnormal metabolism and catabolism related to inflammation. The concept of “pancreatic rest” is not evidence-based. There is however, emerging evidence that supports the use of oral or enteral nutrition to improve nutrition status and to reduce local and systemic inflammation, complications, and death. In mild disease, patients are generally able to initiate solid oral diet and do not require specialized nutrition care such as enteral or parenteral nutrition. In contrast, nutrition interventions are imperative in moderately severe and severe AP. The current article aims to review the latest evidence and suggest practical nutrition interventions in patients with AP, including nutrition requirements, routes of nutrition treatment, types of formula, and the role of nutritional supplements, such as glutamine, probiotics, omega-3 fatty acids, and antioxidants.

Keywords: Acute pancreatitis, Nutrition management, Enteral nutrition, Parenteral nutrition, Nutritional supplement, Nutrition assessment

Core tip: Nutrition intervention helps prevent malnutrition and is a key to reduce inflammation, complications, and death in acute pancreatitis. Current evidence supports the benefits of early enteral nutrition in severe pancreatitis. Gastric and jejunal feeding are equally effective, and polymeric formula is safe, compared to peptide-based formula. Parenteral nutrition should be considered in patients who cannot tolerate enteral nutrition. According to recent data, nutritional supplements, including glutamine, probiotics, omega-3 fatty acids, and antioxidants, may contribute to positive outcomes. While intravenous glutamine shows promising benefits in patients receiving total parenteral nutrition, further studies in other nutritional supplements are needed.