Therapeutic application of feeding strategies in chronic pancreatitis: the potential for jejunal feeding and elemental diet to modulate pancreatic secretion to alleviate painful symptoms

Background: Chronic pancreatitis (CP) often leaves patients with debilitating abdominal pain, postprandial symptom exacerbation, and progressive malnutrition. While traditional management focuses on analgesics and enzyme replacement, strategies aimed to reduce pancreatic secretory stimulation may offer an adjunct to standard approaches. Aim: We explore the physiologic rationale and the existing clinical evidence for jejunal feeding and elemental diets to attenuate pancreatic secretion and improve the symptom burden of CP. Methods: We summarize pancreatic exocrine regulation, emphasizing how nutrient composition and intestinal delivery site shape feedback pathways and pancreatic secretion. We review the physiologic and observational studies of mid-to-distal jejunal tube feeding and elemental diets in animal models, healthy individuals, and patients with CP pain. Results: Studies suggest that jejunal feeding can reduce pancreatic stimulation and may be associated with significant reductions in abdominal pain and analgesic utilization, with improvements in nutritional status. Furthermore, elemental diets, composed of free amino acids, medium-chain triglycerides, and simple carbohydrates, may complement this effect by facilitating efficient nutrient absorption while keeping the pancreas relatively quiescent. However, evidence remains limited by heterogeneity and predominantly nonrandomized study designs. Conclusions: Jejunal feeding and elemental diets represent potential adjunctive strategies for selected CP patients with pain-predominant phenotypes and postprandial symptom exacerbation. Prospective trials are needed to define patient selection, optimal formula, delivery location, durability of benefit, and standardized outcomes regarding patient-reported pain impact, nutritional markers, and treatment-related complications.