Abstract
The poor prognosis of severe acute pancreatitis is incurred from late infectious complications. Most of the complications from late infectious are attributed to bacterial translocation. Nutritional management in severe acute pancreatitis has been emphasized since bacterial translocation plays an important role in the manifestation of infections. Several randomized controlled trials have suggested the strong superiority of enteral nutrition, and meta-analyses have shown significant reductions in the incidence of infectious complications and the length of hospital stay. Enteral nutrition results in clinically relevant and statistically significant risk reduction for infectious complications, pancreatic infections, and mortality in patients with predicted severe acute pancreatitis. The obvious usefulness of enteral nutrition is observed in patients starting within 48 hours after hospitalization. We performed a survey of the conference members of JCNT regarding the implementation of enteral nutrition for acute pancreatitis. However, the most common answer about the starting day of enteral nutrition for acute pancreatitis was 7 days (34% of the hospitals that had answered the inquiry questions). In actuality, there are many problems that restrict enteral nutrition, such as disturbance of bowel movement, high levels of pancreatic enzyme, abdominal pain, and nausea at the time of initiation of enteral nutrition. At present, the administration of elemental diets through a jejunal tube is considered to be the best, however, gastric tube tends to be accepted for early enteral nutrition. It is important to consider that the nutritional management of acute pancreatitis should be judged with carefully taking the patient's condition into consideration. Whenever possible, enteral feeding rather than total parenteral nutrition (TPN) is suggested for patients who require nutritional support. NST team support will have a chance to improve the outcome of severe acute pancreatitis.
