Vaidotas Marcinkevičius1, Agnė Saniukaitė1
1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine
Abstract
Acute pancreatitis (AP) is a lethal disease with no specific treatment. It promotes a systemic inflammatory response syndrome that results in a highly catabolic stress state. The early phase of AP is based on mitochondrial damage, adenosine triphosphate (ATP) depletion and subsequent necrosis in pancreatic cells. A lack of enteral feeding predisposes the increase of intestinal wall permeability and translocation of bacteria that is related to the development of pancreatic infection. Nutritional support is a subject of discussion and plays an important role when AP is diagnosed. The concept of “bowel rest” has evolved over the years. Up to now, current evidence-based guidelines for the initial management of AP prefer enteral nutrition (EN) over parenteral nutrition (PN) as a primary therapy. It decreases mortality rate, reduces risk of multiple organ failure, infectious complications and operative interventions. Also, EN is associated with shorter length of hospital stay (LOS), when compared to PN. EN initiated after 48 h of admission has no statistically significant differences in the risk of multiple organ failure, infectious complications or mortality, when compared with PN. Parenteral feeding initiated early (within 24 h of admission) can worsen the outcomes, compared to standard therapy (no artificial nutrition support). Both of nasogastric (NG) and nasojejunal (NJ) routes are equally beneficial in patients with predicted severe or necrotizing pancreatitis requiring enteral tube feeding. NG feeding, compared to NJ feeding, has no statistical significant differences in the incidence of mortality, tracheal aspiration, diarrhea and pain exacerbation. It is being discussed what is the right time to start nutrition support in patients with AP. Early (within 24 h of admission) enteral feeding is highly recommended in order to preserve gut-mucosal barrier function and reduce bacterial translocation. In summary, current guidelines and recent analyses confirm that EN is considered as a “gold standard” in the management in patients with severe AP and should be administered within 24 h of admission.
Keywords: acute pancreatitis; nutrition support; enteral nutrition; nasogastric feeding; nasojejunal feeding