Evolution of nutritional support in acute pancreatitis

Background: Acute pancreatitis is a catabolic illness and patients with the severe form have high metabolic and nutrient demands. Artificial nutrition al support should therefore be a logical component of treatment. This revie w examines the evidence in favour of initiating nutritional support in thes e patients and the effects of such support on the course of the disease. Methods: Medline and Science Citation Index searches were performed to loca te English language publications on nutritional support in acute pancreatit is in the 25 years preceding December 1999. Manual cross-referencing was al so carried out. Letters, editorials, older review articles and most case re ports were excluded. Results and conclusion: There is no evidence that nutritional support in ac ute pancreatitis affects the underlying disease process, but it may prevent the associated undernutrition and starvation, supporting the patient while the disease continues and until normal and sufficient eating can be resume d. The safety and feasibility of enteral nutrition in acute pancreatitis ha ve been established; enteral nutrition may even be superior to parenteral n utrition. Some patients, however, cannot tolerate enteral feeding and this route may not be practical in others. Parenteral nutrition still has a role , either on its own or in combination with the oral and enteral routes, dep ending on the stage of the illness and the clinical situation.