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World J Gastrointest Surg. Apr 27, 2023; 15(4): 534-543
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.534
Nutrition in acute pancreatitis
Srikanth Gopi, Anoop Saraya, Deepak Gunjan
Srikanth Gopi, Anoop Saraya, Deepak Gunjan, Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Gopi S and Gunjan D contributed to the conceptualization, drafting of the manuscript; Saraya A and Gunjan D critically revised the manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deepak Gunjan, MD, Associate Professor, Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Room 3111, 3rd Floor, Teaching Block, New Delhi 110029, India. drdg_01@rediffmail.com
Received: November 29, 2022
Peer-review started: November 29, 2022
First decision: December 26, 2022
Revised: January 10, 2023
Accepted: March 21, 2023
Article in press: March 21, 2023
Published online: April 27, 2023
Abstract

Acute pancreatitis (AP) has varying severity, and moderately severe and severe AP has prolonged hospitalization and requires multiple interventions. These patients are at risk of malnutrition. There is no proven pharmacotherapy for AP, however, apart from fluid resuscitation, analgesics, and organ support, nutrition plays an important role in the management of AP. Oral or enteral nutrition (EN) is the preferred route of nutrition in AP, however, in a subset of patients, parenteral nutrition is required. EN has various physiological benefits and decreases the risk of infection, intervention, and mortality. There is no proven role of probiotics, glutamine supplementation, antioxidants, and pancreatic enzyme replacement therapy in patients with AP.

Keywords: Acute pancreatitis, Enteral, Parenteral, Nutrition, Malnutrition

Core Tip: Nutrition improves the outcomes of acute pancreatitis (AP). In mild AP, solid food can be given when the patient is pain-free and hungry. In moderately severe and severe pancreatitis, feeding can begin as early as possible if there are no contraindications for an oral diet. If the patient does not tolerate an oral diet, tube feeding can be tried; and in case of gastric outlet obstruction or gastroparesis, nasojejunal tube feeding is preferred. Parenteral nutrition should be provided in case of complete intolerance or contraindications to oral/enteric feed or supplemented along with enteral feed if energy targets are not met.