The current review has summarized current data relevant to the
nutritional support of patients with
acute pancreatitis. Selection of the most appropriate form of
nutritional support for patients with
acute pancreatitis is intimately linked to a thorough understanding of the effects of various forms of enteral and
parenteral nutrition on physiologic exocrine secretory mechanisms. Two basic concepts have emerged from the multiple studies that have addressed these issues to date: 1, enteral feeds should have low fat composition and be delivered distal to the ligament of Treitz to minimize exocrine pancreatic secretion and 2, parenteral substrate infusions, alone or in combinations similar to those administered during TPN, do not stimulate exocrine pancreatic secretion. From a practical standpoint, most patients with
acute pancreatitis are diagnosed by nonoperative means and will manifest some degree of
paralytic ileus during the early phase of the disease. Therefore, jejunal feeds are usually not a therapeutic option early in the course of this disease. On the basis of the clinical studies reviewed herein we propose general guidelines for the
nutritional support of patients with
acute pancreatitis: 1, most patients with mild uncomplicated
pancreatitis (one to two prognostic signs) do not benefit from
nutritional support; 2,
nutritional support should begin early in the course of patients with moderate to severe disease (as soon as hemodynamic and cardiorespiratory stability permit); 3, initial
nutritional support should be through the parenteral route and include fat
emulsion in amounts sufficient to prevent essential
fatty acid deficiency (no objective data exist to recommend specific
amino acid formulations); 4, patients requiring operation for diagnosis or complications of the disease should have a feeding
jejunostomy placed at the time of operation for subsequent
enteral nutrition using a low fat formula, such as Precision HN (Sandoz, 1.3 percent calories as fat), Criticare HN (Mead Johnson, 3 percent calories as fat) or
Vivonex High
Nitrogen (Norwich Eaton, 0.87 percent calories as fat), and 5, oral feedings should be low fat in composition and should be reinstituted using traditional clinical criteria, including the symptoms of the patient, physical examination and computed tomographic appearance of the pancreas (clinicians should bear in mind the well documented exocrine stimulatory effects of even low fat oral feeds and the risks of early refeeding). These general guidelines must be individualized to incorporate what is perhaps the most important clinical variable--the premorbid nutritional state of the patient.(ABSTRACT TRUNCATED AT 400 WORDS)