Nutritional strategies in severe acute pancreatitis: A systematic review of the evidence

Abstract Nutrition in severe acute pancreatitis is a critical aspect in the management of this condition. This review aims to systematically review the evidence available to inform the use of nutritional support in severe acute pancreatitis. High quality (level 1) evidence supports naso–jejunal ente...

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Bibliographic Details
Published in:The surgeon (Edinburgh) 2010-04, Vol.8 (2), p.105-110
Main Authors: Samaraee, Ahmad Al, McCallum, Iain J.D, Coyne, Peter E, Seymour, Keith
Format: Article
Language:English
Subjects:
Acute Disease
Acute pancreatitis
Anti-oxidant
Enteral feeding
Enteral Nutrition
Evidence-Based Medicine
Humans
Intubation, Gastrointestinal
Nutrition
Pancreatitis - immunology
Pancreatitis - therapy
Pancreatitis, Acute Necrotizing - therapy
Probiotic
Probiotics - therapeutic use
Prokinetic
Surgery
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Summary:Abstract Nutrition in severe acute pancreatitis is a critical aspect in the management of this condition. This review aims to systematically review the evidence available to inform the use of nutritional support in severe acute pancreatitis. High quality (level 1) evidence supports naso–jejunal enteral nutrition (NJ-EN) over parenteral nutrition (PN) reducing infectious morbidity and showing a trend towards reduced organ failure although there is no detectable difference in mortality. Trial data may underestimate benefit as patients are often recruited with predicted rather than proven severe disease. NJ-EN is safe when started immediately (level 3 evidence ). NJ-EN is often impractical and naso-gastric (NG) feeding seems to be equivalent in terms of safety and outcomes whilst being more practical (level 2 evidence ). Regarding feed supplementation, probiotic feed supplementation is not beneficial (level 1 evidence ) the and may cause harm with excess mortality (level 2 evidence ). No evidence exists to confirm benefit of the addition of prokinetics in severe acute pancreatitis (SAP) although their use is proven in other critically ill patients. Level 2 evidence does not currently support the use of combination immuno-nutrition though further work on individual agents may provide differing results. Level 2 evidence does not support intravenous supplementation of anti-oxidants and has demonstrated that these too may cause harm.
ISSN:1479-666X
2405-5840
DOI:10.1016/j.surge.2009.10.006