From the Guidelines
Early oral feeding is recommended in acute pancreatitis, within 24 hours, as tolerated, rather than keeping the patient nil per os, according to the American Gastroenterological Association guidelines 1. This approach is supported by the guidelines, which suggest that early feeding can help improve outcomes, such as reducing organ failure, necrosis, and mortality.
- The guidelines recommend early oral feeding, as it is associated with better outcomes, including reduced morbidity and mortality.
- Enteral nutrition is preferred over parenteral nutrition, as it helps maintain gut barrier function, reduces bacterial translocation, and decreases infection rates.
- The specific feeding regimen typically begins with clear liquids and advances to a low-fat solid diet as tolerated, with a target of 25-35 kcal/kg/day and 1.2-1.5 g/kg/day of protein.
- A recent guideline from the European Society for Clinical Nutrition and Metabolism also emphasizes the importance of nutritional support in acute pancreatitis, highlighting the need for early enteral nutrition 1.
- However, the American Gastroenterological Association guidelines 1 provide a stronger recommendation for early oral feeding, with a moderate quality of evidence, making it the preferred approach in clinical practice.
From the Research
Timing of Feedings in Acute Pancreatitis
- The optimal time to start feedings in acute pancreatitis is a topic of ongoing research, with various studies suggesting different approaches 2, 3, 4, 5, 6.
- According to a study published in 2009, enteral nutrition should begin within 24 hours after admission, following the initial period of volume resuscitation and control of nausea and pain 2.
- Another study from 2011 suggests that enteral nutrition should probably be initiated as early as possible, within 48 hours 3.
- A systematic review and meta-analysis published in 2014 found that nasogastric feeding is efficacious in 90% of patients with severe acute pancreatitis, with no significant difference in the delivery of nutritional targets compared to nasojejunal nutrition 4.
- A prospective study from 1997 compared the safety and efficacy of early total enteral nutrition (TEN) vs total parenteral nutrition (TPN) in mild acute pancreatitis, finding that TEN is as safe and effective as TPN, but significantly less costly 5.
- The timing of initiation of oral feeds in acute pancreatitis is still a subject of controversy, with a need for further studies to determine the optimal approach 6.
Key Considerations
- Enteral nutrition is preferred over parenteral nutrition in patients with acute pancreatitis 2, 3, 5.
- The type of enteral feed and the route of administration (e.g. nasogastric vs nasojejunal) may not be as important as the timing of initiation and the overall nutritional support provided 2, 4.
- Patients with mild acute pancreatitis may be started on a low-fat oral diet, while those with severe acute pancreatitis may require enteral nutrition via a gastric or jejunal route 2.