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Salem Health: Nutrition

Pancreatitis, Acute

by Darlene Strayer, RN, MBA, Carita Caple, RN, BSN, MSHS

What We Know

Acute pancreatitis (AP) is typically a potentially fatal inflammatory disorder of the pancreas that develops rapidly and involves multiple organ systems. AP can be mild or severe, with a clinical course that varies widely among patients. Recovery from mild AP is usually uneventful after only supportive treatment (e.g., fluid replacement and pain control). Severe AP involves widespread inflammation and multiple complications that increase the risk for mortality significantly. In addition to the basic supportive care necessary in mild AP, aggressive treatment strategies for severe AP include intensive monitoring of all physiologic systems, prevention of complications, respiratory assistance, nutritional support, and surgical intervention, if necessary. AP generally develops as a result of a disorder related to the obstruction or misdirected secretion of pancreatic enzymes (which digestive function is normally limited to the small intestine).

Nutr-Pancreatitis,_Acute_Nutritional_Support_iStock_000048756144_Illustration.jpg

AP can be caused by any one or more of the following:

  • Pancreatic duct obstruction

  • Hypersecretion of pancreatic enzymes

  • Premature (i.e., before reaching the intestine) activation of pancreatic enzymes as they enter the bile duct

  • Reflux (backup) of pancreatic enzymes and bile into the pancreatic duct

  • Autodigestion (i.e., digestion of tissues by their own secretions) of pancreatic tissue, leading to inflammation

    • Autodigestion in severe AP can damage more pancreatic tissue than that of mild AP; can spread to tissue surrounding the pancreas; and can cause hypercatabolism (i.e., excessive metabolic breakdown of nutrients) which results in rapid weight loss, wasting, and increased risk for mortality

Medical Nutrition Therapy for Pancreatitis

  • Treatment of both mild and severe AP includes restricting all oral intake because eating and drinking may further stimulate secretion of pancreatic digestive enzymes.

    • Patients with severe AP require nutritional support to combat hypercatabolism and prevent the loss of lean body mass.

    • Patients with mild AP typically do not need nutritional support because they recover and can begin eating normally within 57 days; hypercatabolism and malnutrition are rare in mild AP.

      • When symptoms subside, patients with mild AP should initially follow a diet comprised primarily of carbohydrate and protein food sources; dietary fat should be increased gradually in accordance with individual tolerance.

      • Eating heavy meals and drinking alcoholic beverages should be avoided

  • Historically, parenteral nutrition (i.e., providing nutrition via the vascular system) was the feeding method of choice in the treatment of severe AP; however, enteral nutrition (i.e., within the intestines) is the current feeding method of choice. Compared to parenteral feeding, enteral feeding:

    • Is less expensive

    • Is safer and is associated with a lower incidence of complications such as infection, sepsis, thrombosis, organ failure, and metabolic abnormalities e.g., hyperglycemia)

    • Is associated with shorter inpatient length of stays and better clinical outcomes

    • More effectively maintains intestinal blood flow, which prevents atrophy of the intestinal mucosa and maximizes the intestinal barrier function (i.e., of reducing bacterial translocation from the gastrointestinal tract to extraintestinal sites)

      • There is no consensus regarding the optimal time to initiate enteral feeding

      • Patients who are unable to tolerate enteral nutrition may receive parenteral feeding if necessary; some patients are given a combination of enteral and parenteral nutrition

        • Total parenteral nutrition (TPN), alone or in addition to enteral nutrition, may be appropriate for patients who are severely malnourished or have complications (e.g., paralytic ileus)

  • Currently, enteral feeding is most commonly given by nasojejunal tube to patients with severe AP, although there is increasing evidence supporting the viability of feeding via nasogastric tube.

    • Nasogastric feeding is recommended in the management of patients with severe AP because it has several practical advantages. Compared to nasojejunal feeding, nasogastric tube feeding:

      • reduces pancreatic stimulation

      • requires less effort for the initial tube placement and maintenance (nasojejunal tubes require endoscopic placement and replacement)

      • is simpler to use during routine feedings

      • becomes dislocated less frequently

      • is less expensive

    • The composition of standard enteral nutrition formulas may cause pancreatic stimulation because they include fat primarily in the form of long-chain triglycerides (LCTs; e.g., butter) instead of medium-chain triglycerides (MCTs; found naturally in milk fat, palm oil, and coconut oil), which are absorbed more easily and utilized as energy more quickly.

      • Elemental or semi-elemental nutrition formulas containing free amino acids, di-tripeptides, and fat primarily in the form of MCTs are less likely to cause secretion of pancreatic enzymes.

      • The use of immune-enhancing enteral formulas (e.g., those enriched with probiotics [i.e., live microorganisms] and/or omega-3 fatty acids) has not been established to be more beneficial than the use of nonenriched elemental/semi-elemental formulas.

        • Recommended nutrient requirements for patients with severe AP are as follows:

          • Calories: 25–35 kcal/kg/day (1 kg = 2.2 lbs; 1 lb = 0.45 kg)

          • Protein: 1.2–1.5 g/kg/day

          • Carbohydrates: 3–6 g/kg/day

          • Fat: 20 g/day (requirement may be reduced if triglyceride levels are abnormal)

Summary

Individuals diagnosed with mild or severe pancreatitis should learn about nutritional support based on personal characteristics and health needs. Individuals and their family members/caregivers should have an open discussion with healthcare providers regarding the value of enteral nutrition and the safety of nasojejunal and nasogastric routes, as well as understanding the mechanics of the feeding tube and related equipment. Understanding and adhering to proper enteral nutrition support is essential to minimize complications and optimize recovery.

References

1 

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2 

Ferri, F. F. (2013). Pancreatitis, acute. In F. F. Ferri (Ed.), 2013 Ferri’s clinical advisor: 5 books in 1 (pp. 792ߝ794). Philadelphia, PA: Mosby Elsevier.

3 

Friedman, L. S. (2013). Liver, biliary tract, & pancreas disorders. In S. J. McPhee & M. A. Papadakis (Eds.), Lange 2013 current medical diagnosis & treatment (52nd ed., pp. 711ߝ715). New York, NY: McGraw-Hill Medical.

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Frossard, J. L., Steer, M. L., & Pastor, C. M. (2008). Acute pancreatitis. Lancet, 371(9607), 143ߝ152.,. doi:10.1016/S0140-6736(08)60107-5

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Ionnidis, O., Lavrentieva, A., & Botsios, D. (2008). Nutrition support in acute pancreatitis. JOP: Journal of the Pancreas, 9(4), 375ߝ390.

6 

Jiang, K., Chen, X. Z., Xia, Q., Tang, W. F., & Wang, L. (2007). Early nasogastric enteral nutrition for severe acute pancreatitis: A systematic review. World Journal of Gastroenterology: WJG, 13(39), 5253ߝ5260.

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Kingsnorth, A., & O’Reilly, D. (2006). Acute pancreatitis. BMJ(Clinical research ed.), 332(7549), 1072ߝ1076.,. doi:10.1136/bmj.332.7549.1072

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Lankisch, P. G. (2009). Natural course of acute pancreatitis: What we know today and what we ought to know for tomorrow. Pancreas, 38(5), 494ߝ498.,. doi:10.1097/MPA.0b013e3181a11cb0

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McClave, S. A. (2007). Nutrition support in acute pancreatitis. Gastroenterology Clinics of North America, 36(1), 65ߝ74, vi. doi:10.1016/j.gtc.2007.01.002

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O’Keefe, S. J., & Sharma, S. (2007). Nutrition support in severe acute pancreatitis. Gastroenterology Clinics of North America, 36(2), 297ߝ312, viii. doi:10.1016/j.gtc.2007.03.009

11 

Petrov, M. S., Pylypchuk, R. D., & Uchugina, A. F. (2009). A systematic review on the timing of artificial nutrition in acute pancreatitis. British Journal of Nutrition, 101(6), 787ߝ793.,. doi:10.1017/S0007114508123443

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Siow, E. (2008). Enteral versus parenteral nutrition for acute pancreatitis. Critical Care Nurse, 28(4), 19ߝ32. doi:10.1002/14651858.CD002837.pub2

13 

Thomson, A. (2008). Nutritional support in acute pancreatitis. Current Opinion in Clinical Nutrition and Metabolic Care, 11(3), 261ߝ266.,. doi:10.1097/MCO.0b013e3282fba5b4

Reviewers

Gilberto Cabrera, MD, Cinahl Information Systems, Glendale, CA

Kathleen Walsh, RN, MSN, CCRN, Cinahl Information Systems, Glendale, CA

Nursing Practice Council, Glendale Adventist Medical Center, Glendale, CA

Citation Types

Type
Format
MLA 9th
Strayer, Darlene, and Carita Caple. "Pancreatitis, Acute." Salem Health: Nutrition, edited by Sharon Richman, Salem Press, 2016. Salem Online, online.salempress.com/articleDetails.do?articleName=Nutr_0215.
APA 7th
Strayer, D., & Caple, C. (2016). Pancreatitis, Acute. In S. Richman (Ed.), Salem Health: Nutrition. Salem Press. online.salempress.com.
CMOS 17th
Strayer, Darlene and Caple, Carita. "Pancreatitis, Acute." Edited by Sharon Richman. Salem Health: Nutrition. Hackensack: Salem Press, 2016. Accessed December 14, 2025. online.salempress.com.