Nutritional support in acute pancreatitis.

Acute pancreatitis is one of the most catabolic of critical illnesses, and its clinical course is often prolonged. Consequently, the need for interventional nutritional support is great. Because of fears that feeding might exacerbate the tryptic autodigestion and disease process, total parenteral nutrition was used exclusively until recent years, when it was recognized that the complications of hyperglycemia and sepsis outweighed nutritional benefits. In clinical practice, enteral feeding has proven superior because it avoids these complications and maintains gut function, but enteral feeding needs to be given in a form that minimizes pancreatic stimulation. This review discusses the advances in our understanding of the pathophysiology of the disease, the results of recent clinical trials of nutritional support, and the challenges that remain in optimizing nutritional management.