Early enteral feeding in severe acute pancreatitis: Can it prevent secondary pancreatic (super) infection?

Sepsis continues to account for a second peak in mortality in patients with severe acute pancreatitis. The prevention of these septic complications an d subsequent development of multiple organ dysfunction syndrome remains a m ajor focus for investigators, yet despite considerable clinical and experim ental work addressing its etiology, septic complications remain high. Sever al studies have been designed to demonstrate the mechanism of origin of the se septic complications with an attempt to define strategies for their prev ention to improve patient outcomes. There is clear evidence that the origin of this secondary bacterial infection arises from enteric bacterial transl ocation secondary to disruption of the gut mucosal barrier during acute pan creatitis. Strategies designed to prevent secondary pancreatic infection in clude aggressive fluid resuscitation to maximize organ perfusion, early sys temic antibiotic treatment or selective gut decontamination, and recently a ttempts to block mediators of the systemic inflammatory response. This disc ussion will summarize our present understanding of the etiopathogenesis of secondary bacterial 'superinfection' of necrotizing pancreatitis and how th e initiation of enteral feeding early in the course of acute pancreatitis m ay prove to be an effective means of preventing and/or reversing the breakd own of the gut mucosal defense barrier. Copyright (C) 2000 S. Karger AG, Ba sel.