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Review
. 2023 Apr 27;15(4):534-543.
doi: 10.4240/wjgs.v15.i4.534.

Nutrition in acute pancreatitis

Srikanth Gopi  1 , Anoop Saraya  1 , Deepak Gunjan  2
Affiliations
Review

Nutrition in acute pancreatitis

Srikanth Gopi et al. World J Gastrointest Surg. .

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; Malnutrition; Nutrition; Parenteral.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Various probable causes of malnutrition during the course of acute pancreatitis. AP: Acute pancreatitis.
Figure 2
Figure 2
Flowchart of the initiation of nutrition in patients with acute pancreatitis. EN: Enteral nutrition; NRS: Nutritional risk screening; NUTRIC: Nutrition risk in the critically ill; PN: Parenteral nutrition.
Figure 3
Figure 3
Gut barrier dysfunction and its restoration after enteral nutrition. A: Duodenal biopsy from control shows intact claudin-3 positivity on immunohistochemistry in both villi and crypts throughout the mucosa (× 200); B: Biopsy taken from acute pancreatitis (AP) shows loss of claudin-3 positivity in the duodenal villi and crypts (× 200); C: Biopsy taken from AP post-enteral nutrition shows positivity (significant improvement) in the duodenal villi and crypts (× 200). Ultrastructural changes in duodenal epithelia of patients with AP on electron microscopy show disordered microvilli.
Figure 4
Figure 4
Evidence-based physiological and clinical benefits of enteral nutrition compared with total parenteral nutrition in acute pancreatitis[24,26]. AP: Acute pancreatitis; EN: Enteral nutrition.
See this image and copyright information in PMC

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