Abstract
Severe acute pancreatitis (AP) is a hypercatabolic disease characterized by increased energy expenditure and protein breakdown. Traditionally, nutritional support has been provided parenterally due to fears concerning stimulation of the exocrine pancreas and exacerbation of disease. Recently, studies mainly in trauma and burn patients suggested that the gut plays a key role in the development of infection and multiple organ failure and created a trend away from the parenteral route in favor of the enteral route of delivering nutrients. In severe AP, early enteral nutrition (EN) has proven to be safe and in most cases efficacious in terms of providing adequate nutrition. Even more importantly, it seems that EN helps to maintain gut integrity and reduces infectious and inflammatory morbidity. Additionally, in comparison with total parenteral nutrition (TPN), EN is significantly less expensive and eliminates potential septic complications associated with TPN. Therefore, in patients with severe AP, the enteral route is considered the preferred means of nutritional support. The optimal feeding formula has yet to be determined, but at present a semi-elemental or immune-enhancing diet perfused to the jejunum is suggested.