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Nutritional management of acute pancreatitis: the concept of ‘gut rousing’

Petrov, Maxim S.; Windsor, John A.

Current Opinion in Clinical Nutrition & Metabolic Care: September 2013 - Volume 16 - Issue 5 - p 557–563
doi: 10.1097/MCO.0b013e3283638ed1
NUTRITION AND THE GASTROINTESTINAL TRACT: Edited by M. Isabel T.D. Correia and Miquel A. Gassull

Purpose of review: Enteral nutrition has emerged as one of the most effective treatments in the early management of patients with acute pancreatitis. The original rationale for nutrition in acute pancreatitis, dating back to the mid-20th century, was to provide full nutritional requirements but avoid stimulating exocrine pancreatic secretion. The purpose of this article is to review the recent clinical studies of enteral nutrition in acute pancreatitis to revise the rationale and develop a contemporary conceptual framework for nutritional management of this disease.

Recent findings: Several recent randomized controlled trials dispel the outdated concept of ‘pancreatic rest’, which equates with gut neglect, and offer ‘gut rousing’ as a preferred concept. The new concept postulates that gastrointestinal (dys)function has a discernible impact on the outcomes of patients with acute pancreatitis. Further, timely administration of appropriate intraluminal modalities prevents or mitigates the gastrointestinal dysfunction.

Summary: Nutritional management in acute pancreatitis should aim primarily at maintaining the gastrointestinal function. Providing full nutritional requirements and avoiding pancreatic exocrine stimulation should be considered as secondary aims.

Department of Surgery, The University of Auckland, Auckland, New Zealand

Correspondence to Dr Maxim S. Petrov, MD, MPH, PhD, Department of Surgery, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Tel: +64 9 923 2776; fax: +64 9 377 9656; e-mail: max.petrov@gmail.com

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins