Nutritional support in patients with acute pancreatitis. Review of published studies

Abstract

Acute pancreatitis is a common disease that occurs in 5 — 10 % of patients with urgent pathology of the abdominal cavity. The most prevalent metabolic disorders affecting this group of patients are hypermetabolism and hypercatabolism syndromes, which are accompanied by excessive consumption of carbohydrates, fats, and amino acids, increased oxygen intake, and carbon dioxide production. OBJECTIVE — to analyse the current state of the problem of nutritional support for patients with acute pancreatitis. The degree of nutritional disorders in patients with acute pancreatitis varies depending on the etiological factors and severity of the disease, necessitating a differential approach to their correction. Patients with acute pancreatitis experience disruption of the intestinal microflora due to the antibiotic therapy, nutrient and fiber deficiency, and lack of microbial antagonism. This disruption leads to excessive growth of bacteria, particularly gram-negative microflora. The effectiveness and safety of enteral tube feeding are determined by a complex of factors: the timing of recovery of peristalsis and the absorption function of the intestinal wall, the type of mixture, and the method of its administration. Restoration of intestinal absorption in patients with severe acute pancreatitis occurs on average 48 hours after the start of complex conservative therapy. The use of antiflatulents as part of a mixture for enteral nutrition allows to improve the laboratory indicators of blood serum and reduce the frequency of intestinal complications on the 7th day by 21.5 % (2 = 4.88, 95 % CI 2.3 — 39.5, p = 0.03). Nasogastric nutritional support in patients with severe acute pancreatitis is safe and leads to a 25.8 % reduction in the incidence of local infectious complications (2 = 4.59, 95 % CI 2.43 — 45.53, p = 0.03), length of hospital stay by 16 days (p = 0.04), and deaths by 21.4 % (2 = 4.13, 95 % CI 0.81 — 39.68, p = 0.04) in comparison with parenteral nutrition. Nutritional support should be started with nasogastric administration of a food mixture, and in case of complications (intolerance, aspiration, etc.), nasojejunal administration. Parenteral nutrition should be used if enteral nutrition is impossible or not tolerated.