title: Nutrition in acute pancreatitis: a critical review.
abstract: Severe acute pancreatitis poses unique nutritional challenges. The optimal nutritional support in patients with severe acute pancreatitis has been a subject of debate for decades. This review provides a critical review of the available literature. According to current literature, enteral nutrition is superior to parenteral nutrition, although several limitations should be taken into account. The optimal route of enteral nutrition remains unclear, but normal or nasogastric tube feeding seems safe when tolerated. In patients with predicted severe acute pancreatitis an on-demand feeding strategy is advised and when patients do not tolerate an oral diet after 72 hours, enteral nutrition can be started. The use of supplements, both parenteral as enteral, are not recommended. Optimal nutritional support in severe cases often requires a tailor-made approach with day-to-day evaluation of its effectiveness.
authors.affiliation: a Department of Surgery , Jeroen Bosch hospital , s-Hertogenbosch , The Netherlands.
authors.forename: Piet J
authors.initials: PJ
authors.lastname: Lodewijkx
authors.affiliation: b Department of Surgery , Academic Medical Center , Amsterdam , The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: c Department of Gastroenterology and Hepatology , Hospital Gelderse Vallei Ede , Ede , The Netherlands.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Witteman
authors.affiliation: d Department of Gastroenterology and Hepatology , Erasmus MC University Medical Center , Rotterdam , The Netherlands.|e Department of Gastroenterology and Hepatology , St. Antonius Hospital , Nieuwegein , The Netherlands.
authors.forename: Nicolien J
authors.initials: NJ
authors.lastname: Schepers
authors.affiliation: f Department of Operating Theatres and Evidence Based Surgery , Radboud University Medical Center , Nijmegen , The Netherlands.
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.affiliation: b Department of Surgery , Academic Medical Center , Amsterdam , The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: g Department of Surgery , University Medical Center Utrecht , Utrecht , The Netherlands.
authors.forename: Olaf J
authors.initials: OJ
authors.lastname: Bakker
mesh_terms: D000208:Acute Disease; D000818:Animals; D016009:Chi-Square Distribution; D019587:Dietary Supplements / Q000009:adverse effects; D004750:Enteral Nutrition / Q000009:adverse effects; D006801:Humans; D009752:Nutritional Status; D010195:Pancreatitis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010288:Parenteral Nutrition / Q000009:adverse effects; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Acute Pancreatitis; Enteral Nutrition; Management; Nutrition; Parenteral Nutrition; mortality; necrotizing pancreatitis