CLINICAL NUTRITION IN PANCREATITIS

In patients with acute pancreatitis or an acute flare of chronic pancr eatitis, a discrepancy exists between increased protein/calorie requir ements induced by a hypermetabolic stress state and reduced ingestion/ assimilation of exogenous nutrients, which promotes progressive nutrit ional deterioration. Patients with severe pancreatitis (defined by gre ater than or equal to 3 Ranson criteria, an APACHE II score of greater than or equal to 10, development of major organ failure, and/or prese nce of pancreatic necrosis) are more likely to require aggressive nutr itional support than patients with mild disease. The type of formula a nd level of the gastrointestinal tract into which nutrients are infuse d determine the degree to which pancreatic exocrine secretion is stimu lated. Animal studies and early prospective randomized controlled tria ls in humans suggest that total enteral nutrition via jejunal feeding may be the preferred route to parenteral alimentation in this disease setting.