Nutritional support in acute pancreatitis: a review of clinical guidelines

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In recent years, nutritional support in acute pancreatitis has undergone significant changes. For a long time, treatment was based on the concept of pancreatic rest, which implied fasting and total parenteral nutrition. However, recent studies have demonstrated a clear advantage of early oral or enteral feeding. Nevertheless, many issues related to the tactics and composition of nutritional support remain unresolved. This review presents current data on nutritional support as part of comprehensive therapy for acute pancreatitis. A scientific data search was conducted in the eLIBRARY.RU, PubMed, and ScienceDirect databases using the keywords: “acute pancreatitis,” “nutritional support,” “probiotics,” “glutamine,” “omega-3 fatty acids” and “guidelines”. The analysis showed that oral or enteral nutrition should be initiated as early as possible—within the first 24–48 hours after hospital admission. The review addresses methods of intragastric and postpyloric nutrient administration, indications for percutaneous gastro- or jejunostomy placement, and also presents current perspectives on the necessity of additional administration of pharmaconutrients and probiotics. In addition, an algorithm for prescribing nutritional support in acute pancreatitis is provided. Accumulated evidence confirms that early oral or enteral nutrition is an essential component of intensive care for patients with acute pancreatitis.