Topic Highlight
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 14, 2013; 19(42): 7267-7275
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7267
Nutrition in chronic pancreatitis
Henrik Højgaard Rasmussen, Øivind Irtun, Søren Schou Olesen, Asbjørn Mohr Drewes, Mette Holst
Henrik Højgaard Rasmussen, Mette Holst, Centre for Nutrition and Bowel Disease (CET), Department of Gastroenterology and Hepatology, Aalborg University Hospital, Faculty of Health, Aalborg University, 9000 Aalborg, Denmark
Øivind Irtun, Department of Gastroenterologic Surgery, University Hospital North-Norway, 9013 Tromsø, Norway
Søren Schou Olesen, Asbjørn Mohr Drewes, Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark
Author contributions: All authors contributed to this review.
Correspondence to: Henrik Højgaard Rasmussen, PhD, Professor, Consultant, Head of Centre for Nutrition and Bowel Disease (CET), Department of Gastroenterology and Hepatology, Aalborg University Hospital, Faculty of Health, Aalborg University, 9000 Aalborg, Denmark. hhr@rn.dk
Telephone: +45-99-326229 Fax: +45-99-326507
Received: June 20, 2013
Revised: September 24, 2013
Accepted: October 19, 2013
Published online: November 14, 2013
Processing time: 150 Days and 12.8 Hours
Abstract

The pancreas is a major player in nutrient digestion. In chronic pancreatitis both exocrine and endocrine insufficiency may develop leading to malnutrition over time. Maldigestion is often a late complication of chronic pancreatic and depends on the severity of the underlying disease. The severity of malnutrition is correlated with two major factors: (1) malabsorption and depletion of nutrients (e.g., alcoholism and pain) causes impaired nutritional status; and (2) increased metabolic activity due to the severity of the disease. Nutritional deficiencies negatively affect outcome if they are not treated. Nutritional assessment and the clinical severity of the disease are important for planning any nutritional intervention. Good nutritional practice includes screening to identify patients at risk, followed by a thoroughly nutritional assessment and nutrition plan for risk patients. Treatment should be multidisciplinary and the mainstay of treatment is abstinence from alcohol, pain treatment, dietary modifications and pancreatic enzyme supplementation. To achieve energy-end protein requirements, oral supplementation might be beneficial. Enteral nutrition may be used when patients do not have sufficient calorie intake as in pylero-duodenal-stenosis, inflammation or prior to surgery and can be necessary if weight loss continues. Parenteral nutrition is very seldom used in patients with chronic pancreatitis and should only be used in case of GI-tract obstruction or as a supplement to enteral nutrition.

Keywords: Chronic pancreatitis; Malnutrition; Nutritional risk; Malabsorption; Nutritional risk screening; Metabolism; Nutritional assessment; Nutrition therapy

Core tip: The pancreas is a major player in nutrient digestion and malnutrition is frequently found but is often neglected. The severity of malnutrition is correlated with malabsorption and depletion of nutrients (e.g., alcoholism and pain) that causes impaired nutritional status and increased metabolic activity due to the severity of the disease. Good nutritional practice includes screening to identify patients at nutritional risk, followed by a thoroughly nutritional assessment and nutrition plan for risk patients. Treatment should be multidisciplinary and the mainstay of treatment is abstinence from alcohol, pain treatment, dietary modifications and pancreatic enzyme supplementation.