Recent Advances on Nutrition in Treatment of Acute Pancreatitis

Abstract

Acute pancreatitis (AP) is a common abdominal acute inflammatory disorder and the leading cause of hospital admission for gastrointestinal disorders in many countries. Clinical manifestations of AP vary from self-limiting local inflammation to devastating systemic pathological conditions causing significant morbidity and mortality. To date, despite extensive efforts in translating promising experimental therapeutic targets in clinical trials, disease-specific effective remedy remains obscure, and supportive care has still been the primary treatment for this disease. Emerging evidence, in light of the current state of pathophysiology of AP, has highlighted that strategic initiation of nutrition with appropriate nutrient supplementation are key to limit local inflammation and to prevent or manage AP-associated complications. The current review focuses on recent advances on nutritional interventions including enteral versus parenteral nutrition strategies, and nutritional supplements such as probiotics, glutamine, omega-3 fatty acids, and vitamins in clinical AP, hoping to advance current knowledge and practice related to nutrition and nutritional supplements in clinical management of AP.

Keywords: amino acids; clinical management of acute pancreatitis; nutritional interventions; omega-3 fatty acids; prebiotics; probiotics; vitamins.

Figure 1

Pathophysiology of acute pancreatitis highlighting sites of action by nutrition. Etiological stress triggers premature activation of digestive zymogens and intra-acinar cellular injury with accompanying oxidative stress. Involvement of immune cells with released inflammatory mediators and amplified oxidative stress exacerbate the inflammatory cascade. Gut inflammation and barrier failure occur following systemic inflammatory responses, vascular disturbance, and ischemia/reperfusion injury secondary to pancreatic inflammation. Disrupted barrier function further leads to bacterial translocation, pancreatic infection and necrosis, and endotoxemia, ultimately responsible for multiple organ dysfunction syndrome (MODS) and death.

Figure 2

Targeted nutritional interventions during the whole episode of acute pancreatitis. Targeted nutritional interventions: enteral or parental nutrition and nutritional supplements including anti-inflammatory immunonutrients, antioxidants, and probiotics are presented at the administration stage.