Nutritional support in acute pancreatitis.

That pancreatic rest and a reduction in exocrine secretion may allow a more expedient resolution of pancreatic inflammation is an important clinical precept in the management of patients with acute pancreatitis. Fortunately, the most common deleterious effect of early advancement to oral diet is an uncomplicated exacerbation of symptoms, which in one multi-center trial occurred in 21% of patients recovering from acute pancreatitis [1]. Of greater concern is a true exacerbation of pancreatitis, which occurs in less than one fifth of those patients who demonstrate an exacerbation of symptoms (or in 4.3% of patients overall) [1]. Relapse in response to early advancement to oral diet does impact patient outcome with regard to length of hospitalization. Length of hospitalization after advancement to oral diet was prolonged from 7 days in those patients who advanced successfully, to 18 days in those patients who suffered relapse [1]. Total length of hospitalization was nearly doubled from 18 to 33 days (p 0.002), when relapse occurred in response to early advancement to oral diet [1]. The development of late complications of major peripancreatic infection in response to early dietary advancement described in early retrospective studies [2] has not been demonstrated in more recent prospective studies. The understanding of what constitutes pancreatic rest has improved over the past decade. A reduction in the enzymatic protein portion of pancreatic exocrine secretion appears to be the most important factor in resolving the inflammatory response. While fluid volume and bicarbonate output from the pancreas are often simultaneously stimulated with increases in protein