Abstract
Acute pancreatitis is a model of local and systemic immunoinflammation with a clinical spectrum incorporating the systemic inflammatory response syndrome (SIRS), sepsis, multiple organ failure (MOF), and death (1,2). A failure of the gut barrier to exclude endogenous bacteria, toxins and antigens from the portal and systemic circulation is incriminated in the modern paradigm of SIRS, sepsis and MOF (3). The gut has enhanced nutritional, metabolic and oxygen requirements in an established immunoinflammatory state (4). The rationale for feeding the gut using enteral nutrition is to support these needs and thus enhance local immune and barrier functions. Early enteral feeding has shown clinical benefit in other models of systemic immunoinflammation, including burns (5) and trauma (6), but its value as a therapeutic modality in acute pancreatitis has received scant experimental or clinical attention.
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References
Formela LJ, Galloway SW, Kingsnorth AN (1995) Inflammatory mediators in acute pancreatitis. Br J Surg 82:6–13.
Steinberg W, Tenner S (1994) Acute pancreatitis. N Engl J Med 330:1198–1210.
Deitch EA (1992) Multiple organ failure. Pathophysiology and potential future therapy. Ann Surg 216:117–132.
Wilmore DW, Smith RJ, O’Dwyer ST, Jacobs DO, Ziegler TR, Wang XD (1988) The gut: a central organ after surgical stress. Surgery 104:917–923.
Alexander JW, MacMillan BG, Stinnett JD et al. (1980) Beneficical effects of aggressive protein feeding in severely burned children. Ann Surg 192:505–517.
Moore FA, Feliciano DV, Andrassy RJ et al. (1992) Early enteral nutrition, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 216:172–183.
Pisters PWT, Ranson JHC (1992) Nutritional support for acute pancreatitis. Surg Gynecol Obstet 175:275–284.
Marulendra S, Kirby DF (1995) Nutrition support in pancreatitis. Nutr Clin Pract 10:45–53.
Ragins H, Levenson SM, Singer R et al. (1973) Intrajejunal administration of an elemental diet at neutral pH avoids pancreatic stimulation. Am J Surg 126:606–614.
Kelly GA, Nahrwold AL. (1976) Pancreatic secretion in response to an elemental diet and intravenous hyperalimentation. Surg Gynecol Obstet 143:87–91.
Keith RG (1980) Effect of a low fat elemental diet on pancreatic secretion during pancreatitis. Surg Gynecol Obstet 151:337–343.
Voitk A, Brown RA, Echave V et al. (1973) Use of an elemental diet in the treatment of complicated pancreatitis. Am J Surg 125:223–227.
Parekh D, Lawson HH, Sigal I (1993) The role of total enteral nutrition in pancreatic disease. SAfr J Surg 31:57–61.
Kudsk KA, Campbell SM, O’Brien T, Fuller R (1990) Postoperative enteral feeding following complicated pancreatitis. Nutr Clin Pract 5:14–17.
McClave S, Greene LM, Snider H et al. (1997) Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. JPEN 21:14–20.
Ranson JHC, Spencer FC (1977) Prevention, diagnosis and treatment of pancreatic abscess. Surgery 82:99–106.
Feller JH, Brown RA, MacLaren-Toussant GP et al. (1974) Changing methods in the treatment of severe pancreatitis. Am J Surg 127:196–201.
Sitzmann JV, Steinborn PA, Zinner MJ et al. (1989) Total parenteral nutrition and alternate energy substrates in treatment of severe acute pancreatitis. Surg Gynecol Obstet 168:311–317.
Kalfarentzos FE, Karafios DD, Karatzas TM et al. (1991) Total parenteral nutrition in severe acute pancreatitis. J Am Coll Nutr 10:156–162.
Sax HC, Warner BW, Talamini MA et al. (1987) Early total parenteral nutrition in acute pancreatitis: lack of beneficial effects. Am J Surg 153:117–124.
Isenmann R, Buchler MW (1994) Infection and acute pancreatitis. Br J Surg 81:1707–1708.
Johnson CD (1996) Antibiotic prophylaxis in severe acute pancreatitis. Br J Surg 83:883–884.
Tran DD, Cuesta MA, Scneider JA, Wesdorp RIC (1993) Multiple organ failure in patients with acute pancreatitis. J Crit Care 8:145–153
Reynolds JV (1996) Gut barrier function in the surgical patient. Br J Surg 83:1668–1669.
Ryan CM, Schmidt J, Lewandrowski K et al. (1993) Gut macromolecular permeability in pancreatitis correlates with severity of disease in rats. Gastroenterology 104:890–895.
Luiten EJT, Hop WCJ, Lange JF, Bruining HA (1995) Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis. Ann Surg 222:57–65.
Sainio V, Kemppainen E, Pouillakkainen P et al. (1995) Early antibiotic treatment in acute necrotising pancreatitis. Lancet 346:663–667.
Peterson VN, Moore EE, Jones TN et al. (1988) Total enteral nutrition versus total parenteral nutrition after major torso injury: attenuation of hepatic protein reprioritization. Surgery 104:199–207.
Windsor ACJ, Li A, Gurthrie A et al. (1996) Feeding the gut in pancreatitis: a randomised clinical trial of enteral versus parenteral nutrition. Br J Surg 83:689 (abstract).
Bone RC, Sibbald WJ, Sprung CL (1992) The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 101:1481–1483.
Tran DD, Groeneveld AB, van der Muelen J et al. (1990) Age, chronic disease, sepsis, organ system failure and mortality in a medical intensive care unit. Crit Care Med 18:474–479.
Balthazar EJ, Robinson DL, Megibow AJ, Ranson JHC (1990) Acute pancreatitis; value of CT in establishing the prognosis. Radiology 1990;174:331–336.
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Reynolds, J.V. (1999). Enteral Nutrition in Acute Pancreatitis. In: Johnson, C.D., Imrie, C.W. (eds) Pancreatic Disease. Springer, London. https://doi.org/10.1007/978-1-4471-0801-6_12
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DOI: https://doi.org/10.1007/978-1-4471-0801-6_12
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