Enteral nutrition and immune modulation of acute pancreatitis

Table 1 Current nutrition practice guidelines of enteral nutrition in patients with severe acute pancreatitis

Association	Recommendation for nutritional care of SAP (Grade)
International Consensus Guideline Committee[28]	EN is generally preferred over PN, or at least EN should, if feasible, be initiated first. (Grade A: Platinum)
	For EN, consider small peptide-based, medium chain triglyceride oil formula to improve tolerance. (Grade B: Gold)
European Society of Parenteral and Enteral Nutrition[29]	In severe necrotizing pancreatitis, EN is indicated if possible (A)
	Peptide-based formula can be used safely in AP (A)
	Standard formula can be tried if they are tolerated (C)
ASPEN/SCCM 2009 Critical Care Guidelines[30]	Patients with severe acute pancreatitis may be fed enterally by the gastric or jejunal route. (Grade: C)
	Tolerance to EN in patients with severe acute pancreatitis may be enhanced by the following measures: Changing the content of the EN delivered from intact protein to small peptides, and long-chain fatty acids to medium-chain triglycerides of a nearly fat-free elemental formulation. (Grade: E)
American College of Gastroenterology[31]	In severe AP, EN is recommended to prevent infectious complications
	Parenteral nutrition should be avoided unless the enteral route is not available, not tolerated or not meeting caloric requirements (strong recommendation, high quality of evidence)

SAP: Severe acute pancreatitis; EN: Enteral nutrition.